Provider Demographics
NPI:1730310251
Name:MERCY PHILLIPS HEALTH CENTER
Entity Type:Organization
Organization Name:MERCY PHILLIPS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-567-5593
Mailing Address - Street 1:244 E PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-2222
Mailing Address - Country:US
Mailing Address - Phone:312-567-7058
Mailing Address - Fax:312-328-7982
Practice Address - Street 1:244 E PERSHING RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-2222
Practice Address - Country:US
Practice Address - Phone:312-567-7058
Practice Address - Fax:312-328-7982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL & MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-31
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001578261QS1000X
IL771115016291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL771115016OtherDHS
IL14D1036279OtherCLIA