Provider Demographics
NPI:1023105566
Name:INGALLS MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:INGALLS MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:NEISWONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-915-1111
Mailing Address - Street 1:1 INGALLS DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3558
Mailing Address - Country:US
Mailing Address - Phone:708-915-6107
Mailing Address - Fax:708-915-2099
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3558
Practice Address - Country:US
Practice Address - Phone:708-915-6107
Practice Address - Fax:708-915-2099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INGALLS MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001099273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14T191Medicare Oscar/Certification