Provider Demographics
NPI:1619903119
Name:TINLEY ORLAND MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:TINLEY ORLAND MEDICAL CENTER LLC
Other - Org Name:ADVOCATE CHRIST CARDIOVASCULAR INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AMBULATORY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-684-5014
Mailing Address - Street 1:18210 LA GRANGE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487
Mailing Address - Country:US
Mailing Address - Phone:708-342-7950
Mailing Address - Fax:708-342-7962
Practice Address - Street 1:18210 LA GRANGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487
Practice Address - Country:US
Practice Address - Phone:708-342-7950
Practice Address - Fax:708-342-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634400OtherBCBS GROUP
ILDC0037OtherRAILROAD MEDICARE GRP
IL01634400OtherBCBS GROUP