Provider Demographics
NPI:1619918497
Name:MERCY HOSPITAL D&T CLINIC
Entity Type:Organization
Organization Name:MERCY HOSPITAL D&T CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIPIOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-567-5578
Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:1ST FLR.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-2128
Mailing Address - Fax:312-328-7702
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:1ST FLR.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2128
Practice Address - Fax:312-328-7702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL & MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBSIL
IL3720708OtherFQHC SITE
IL950150Medicare PIN
IL140158Medicare PIN