Provider Demographics
NPI:1659740033
Name:PRESENCE HOSPITALS PRV
Entity Type:Organization
Organization Name:PRESENCE HOSPITALS PRV
Other - Org Name:PRESENCE SAINT JOSEPH MEDICAL CENTER - PED/ENDO CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIMEROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-337-2740
Mailing Address - Street 1:10330 W ROOSEVELT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2571
Mailing Address - Country:US
Mailing Address - Phone:815-405-6285
Mailing Address - Fax:
Practice Address - Street 1:301 MADISON ST
Practice Address - Street 2:SUITE 302
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6549
Practice Address - Country:US
Practice Address - Phone:815-405-6285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty