Provider Demographics
NPI:1245370907
Name:EDWARD HINES VA HOSPITAL
Entity type:Organization
Organization Name:EDWARD HINES VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED RESPIRATORY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BINI
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:THECCANAT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:708-202-8387
Mailing Address - Street 1:1417 CAROL ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1205
Mailing Address - Country:US
Mailing Address - Phone:847-692-1956
Mailing Address - Fax:
Practice Address - Street 1:1417 CAROL ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1205
Practice Address - Country:US
Practice Address - Phone:847-692-1956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILTAXUPINVAD000Medicare UPIN