Provider Demographics
NPI:1780686758
Name:MERIT LINCOLN PARK LLC
Entity Type:Organization
Organization Name:MERIT LINCOLN PARK LLC
Other - Org Name:LINCOLN PARK HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANSORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-883-3809
Mailing Address - Street 1:550 W WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3965
Mailing Address - Country:US
Mailing Address - Phone:773-883-3800
Mailing Address - Fax:773-883-5168
Practice Address - Street 1:550 W WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3965
Practice Address - Country:US
Practice Address - Phone:773-883-3800
Practice Address - Fax:773-883-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:2006-11-21
Deactivation Code:
Reactivation Date:2007-04-03
Provider Licenses
StateLicense IDTaxonomies
IL1683805273Y00000X
IL0005256273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered273Y00000XHospital UnitsRehabilitation Unit
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========402Medicaid
IL=========402Medicaid