COOK COUNTY (PROVIDENT HOSPITAL OF COOK COUNTY) - NPI NUMBER 1487664561

Summary

Provider Name: COOK COUNTY (PROVIDENT HOSPITAL OF COOK COUNTY)

NPI Number: 1487664561

Clasification: General Acute Care Hospital (282N00000X)

Address:
500 EAST 51ST STREET
CHICAGO, IL
ZIP 60615

Phone Number: (312) 572-1200



Detailed Information

COOK COUNTY is a general acute care hospital in Chicago, IL. The provider is an acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. The assigned NPI number for this provider is 1487664561 and is registered as an organization entity type.
The provider Is Doing Business As Provident Hospital Of Cook County.

The provider's business address is:

500 EAST 51ST STREET
CHICAGO, IL
ZIP 60615-494
Phone: (312) 572-1200
Fax: (312) 572-1294

The provider's authorized official is Robert Vais .
The authorized official title is Director Of Cost And Reimbursement and has the following contact phone number (312) 864-4665.

The enumeration date for this NPI number is 8/9/2006 and was last updated on 7/27/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 282N00000X General Acute Care Hospital 0004549 IL Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 14-0300 MEDICARE ID-TYPE UNSPECIFIED IL
2 93 OTHER IL BLUE CROSS BLUE SHIELD

NPI Record

No. Field Name Field Value
1 NPI 1487664561
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name COOK COUNTY
5 Provider Other Organization Name PROVIDENT HOSPITAL OF COOK COUNTY
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 500 EAST 51ST STREET
8 Provider Business Practice Location Address City Name CHICAGO
9 Provider Business Practice Location Address State Name IL
10 Provider Business Practice Location Address Postal Code 606152494
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 3125721200
13 Provider Business Practice Location Address Fax Number 3125721294
14 Provider Enumeration Date 8/9/2006
15 Last Update Date 7/27/2012
16 Authorized Official Last Name VAIS
17 Authorized Official First Name ROBERT
18 Authorized Official Title or Position DIRECTOR OF COST AND REIMBURSEMENT
19 Authorized Official Telephone Number 3128644665
20 Healthcare Provider Taxonomy Code 1 282N00000X
21 Provider License Number 1 0004549
22 Provider License Number State Code 1 IL
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 14-0300
25 Other Provider Identifier Type Code 1 04
26 Other Provider Identifier State 1 IL
27 Other Provider Identifier 2 93
28 Other Provider Identifier Type Code 2 01
29 Other Provider Identifier State 2 IL
30 Other Provider Identifier Issuer 2 BLUE CROSS BLUE SHIELD
31 Is Organization Subpart N
32 Authorized Official Name Prefix Text MR.

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.