Provider Demographics
NPI:1356601751
Name:WEISS MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:WEISS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL ASSISTANTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAKKA
Authorized Official - Middle Name:ARUNA
Authorized Official - Last Name:KUMARI
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:630-702-9951
Mailing Address - Street 1:2400 DANBURY DR APT B2
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2091
Mailing Address - Country:US
Mailing Address - Phone:630-702-9951
Mailing Address - Fax:
Practice Address - Street 1:655 ROCKLAND RD
Practice Address - Street 2:STE 211
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1782
Practice Address - Country:US
Practice Address - Phone:630-702-9951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000178282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital