Provider Demographics
NPI:1669554507
Name:PROVIDENT HOSPITAL OF COOK COUNTY
Entity type:Organization
Organization Name:PROVIDENT HOSPITAL OF COOK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-572-2370
Mailing Address - Street 1:500 E 51ST ST
Mailing Address - Street 2:DEPARTMENT OF GENERAL SURGERY, ROOM 7058
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2400
Mailing Address - Country:US
Mailing Address - Phone:312-572-2664
Mailing Address - Fax:312-572-2681
Practice Address - Street 1:500 E 51ST ST
Practice Address - Street 2:DEPARTMENT OF GENERAL SURGERY, ROOM 7058
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2400
Practice Address - Country:US
Practice Address - Phone:312-572-2664
Practice Address - Fax:312-572-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001953363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty