Provider Demographics
NPI: | 1760432348 |
---|---|
Name: | SWEDISH COVENANT MANAGEMENT SERVICES, INC. |
Entity Type: | Organization |
Organization Name: | SWEDISH COVENANT MANAGEMENT SERVICES, INC. |
Other - Org Name: | SWEDISH COVENANT MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | AVP, PHYSICIAN SERVICES AND CVO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | CARRIE |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | BRADFORD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MHA, RHIA, CPMSM, CP |
Authorized Official - Phone: | 847-570-2041 |
Mailing Address - Street 1: | 2650 RIDGE AVE STE 1223 |
Mailing Address - Street 2: | |
Mailing Address - City: | EVANSTON |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60201-1700 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 847-570-2040 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5140 N CALIFORNIA AVE |
Practice Address - Street 2: | |
Practice Address - City: | CHICAGO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60625-3645 |
Practice Address - Country: | US |
Practice Address - Phone: | 847-570-2040 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-12 |
Last Update Date: | 2021-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103T00000X, 207Q00000X, 207R00000X, 207RE0101X, 207RG0100X, 207T00000X, 207V00000X, 208100000X, 2084N0400X, 208G00000X, 363A00000X, 363L00000X, 364SA2100X, 367A00000X | ||
IL | 036097505 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
No | 364SA2100X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care | Group - Multi-Specialty |
No | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
406120 | Medicare ID - Type Unspecified |