Provider Demographics
NPI:1750562187
Name:31ST STREET MEDICAL CENTER S.C.
Entity type:Organization
Organization Name:31ST STREET MEDICAL CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-429-7373
Mailing Address - Street 1:16750 80TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3173
Mailing Address - Country:US
Mailing Address - Phone:708-429-7373
Mailing Address - Fax:708-429-7340
Practice Address - Street 1:16750 80TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3173
Practice Address - Country:US
Practice Address - Phone:708-429-7373
Practice Address - Fax:708-429-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL966980Medicare PIN