Provider Demographics
NPI:1629220546
Name:VA HOSPITAL
Entity Type:Organization
Organization Name:VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUCLEAR MEDICINE TECHNOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIEJA
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT
Authorized Official - Phone:312-206-6000
Mailing Address - Street 1:205 W RAVINE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1455
Mailing Address - Country:US
Mailing Address - Phone:312-206-6000
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL032417286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital