Provider Demographics
NPI:1932438108
Name:JESSE BROWN VA MEDICAL CENTER
Entity Type:Organization
Organization Name:JESSE BROWN VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PT
Authorized Official - Prefix:MS
Authorized Official - First Name:TOSAPORN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIT-ARKHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:312-569-6397
Mailing Address - Street 1:215 W 59TH ST
Mailing Address - Street 2:APT 17
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 W 59TH ST
Practice Address - Street 2:APT 17
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4973
Practice Address - Country:US
Practice Address - Phone:312-569-6397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital