Provider Demographics
NPI:1659429900
Name:MOUNT SINAI HOSPITAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MOUNT SINAI HOSPITAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-257-4793
Mailing Address - Street 1:2750 W 15TH ST
Mailing Address - Street 2:KURTZON 10TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1610
Mailing Address - Country:US
Mailing Address - Phone:773-257-4793
Mailing Address - Fax:773-257-5887
Practice Address - Street 1:2750 W 15TH ST
Practice Address - Street 2:KURTZON 10TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1610
Practice Address - Country:US
Practice Address - Phone:773-257-4793
Practice Address - Fax:773-257-5887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1000371251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL=========003Medicaid