Provider Demographics
NPI:1265784193
Name:INGALLS MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:INGALLS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-915-5003
Mailing Address - Street 1:ONE INGALLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426
Mailing Address - Country:US
Mailing Address - Phone:708-915-5003
Mailing Address - Fax:
Practice Address - Street 1:ONE INGALLS DRIVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-915-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013962282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital