Provider Demographics
NPI:1679627376
Name:SAINTS MARY AND ELIZABETH MEDICAL CENTER
Entity type:Organization
Organization Name:SAINTS MARY AND ELIZABETH MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR, PFS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PFISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-792-9903
Mailing Address - Street 1:1431 N CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1702
Mailing Address - Country:US
Mailing Address - Phone:773-278-2000
Mailing Address - Fax:
Practice Address - Street 1:1127 N OAKLEY BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3507
Practice Address - Country:US
Practice Address - Phone:773-572-8500
Practice Address - Fax:773-572-8568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0049OtherBX IL PROVIDER NUMBER
IL=========011Medicaid
140094Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER