Provider Demographics
NPI:1972855963
Name:BLUE ISLAND HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:BLUE ISLAND HOSPITAL COMPANY LLC
Other - Org Name:METRO SOUTH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3672
Mailing Address - Street 1:12935 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2428
Mailing Address - Country:US
Mailing Address - Phone:708-597-2000
Mailing Address - Fax:708-389-9480
Practice Address - Street 1:12935 GREGORY ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2428
Practice Address - Country:US
Practice Address - Phone:708-597-2000
Practice Address - Fax:708-389-9480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE ISLAND HOSPITAL COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-15
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005835273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14S118Medicare Oscar/Certification