Provider Demographics
NPI:1740320407
Name:EDWARD HINES VA HOSPITAL
Entity type:Organization
Organization Name:EDWARD HINES VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAJU
Authorized Official - Middle Name:P
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:708-202-2001
Mailing Address - Street 1:2217 SHANNON CT
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-8457
Mailing Address - Country:US
Mailing Address - Phone:630-985-3548
Mailing Address - Fax:630-985-3806
Practice Address - Street 1:2217 SHANNON CT
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-8457
Practice Address - Country:US
Practice Address - Phone:630-985-3548
Practice Address - Fax:630-985-3806
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
ILUPINVAD000OtherNPPES