Provider Demographics
NPI:1841333788
Name:LITTLE COMPANY OF MARY HOSPITAL INC
Entity type:Organization
Organization Name:LITTLE COMPANY OF MARY HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-229-5004
Mailing Address - Street 1:9800 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3617
Mailing Address - Country:US
Mailing Address - Phone:708-229-4663
Mailing Address - Fax:708-499-5975
Practice Address - Street 1:9800 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3617
Practice Address - Country:US
Practice Address - Phone:708-229-4663
Practice Address - Fax:708-499-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0161859661OtherBCBS OF IL
ILCC0511OtherRR MEDICARE
IL815320Medicare ID - Type Unspecified