Provider Demographics
NPI:1679198014
Name:INGALLS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:INGALLS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REV PERF AND AUDIT MGT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-702-6890
Mailing Address - Street 1:6701 159TH ST STE B105
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 159TH ST STE B105
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1758
Practice Address - Country:US
Practice Address - Phone:708-915-7580
Practice Address - Fax:708-225-7532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INGALLS MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy