Provider Demographics
NPI:1629076831
Name:SSM REGIONAL HEALTH SERVICES OWNING AND OPERATING ST FRANCIS HOSPITAL
Entity Type:Organization
Organization Name:SSM REGIONAL HEALTH SERVICES OWNING AND OPERATING ST FRANCIS HOSPITAL
Other - Org Name:ST. FRANCIS HOSPITAL & HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNADAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-597-2000
Mailing Address - Street 1:12935 GREGORY ST
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2428
Mailing Address - Country:US
Mailing Address - Phone:708-597-2000
Mailing Address - Fax:708-389-9480
Practice Address - Street 1:12935 GREGORY ST
Practice Address - Street 2:ADMINISTRATION
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:708-597-2000
Practice Address - Fax:708-389-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005116282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361721730OtherOLD FEDERAL TAX ID
IL361721730OtherOLD FEDERAL TAX ID
IL361721730OtherOLD FEDERAL TAX ID