Provider Demographics
NPI:1740408186
Name:SWEDISH COVENANT HOSPITAL
Entity Type:Organization
Organization Name:SWEDISH COVENANT HOSPITAL
Other - Org Name:ROOSEVELT HIGH SCHOOL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE & BUSINESS PLAN
Authorized Official - Prefix:
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KULENOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-8200
Mailing Address - Street 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 635-645
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-293-3223
Mailing Address - Fax:
Practice Address - Street 1:3436 W WILSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5318
Practice Address - Country:US
Practice Address - Phone:773-534-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========010Medicaid