NPIMap

Organization Active NPI

Loyola University Medical Center

  • Eyewear Supplier
  • Maywood, IL
National Provider Identifier
1073859104
Registry record updated Jul 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
LOYOLA UNIVERSITY MEDICAL CENTER
Practice address
2160 S 1St Ave
Outpatient Center Room 1620
Maywood, IL 60153-3328
Phone
(708) 216-9000
Fax
(708) 216-8059
NPI assigned
Dec 18, 2012
Last updated
Jul 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Larry M Goldberg
Title
Ceo
Phone
(708) 216-3215

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

2160 S 1St Ave
Outpatient Center Room 1620
Maywood, IL 60153-3328

Mailing address

2160 S 1St Ave
Outpatient Center Room 1620
Maywood, IL 60153-3328
Phone (708) 216-9000

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2160 S 1st Ave
Rm 1620
Maywood, IL 60153
Phone (708) 216-4746

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436140800000",
    "number": "1073859104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "OUTPATIENT CENTER ROOM 1620",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-9000",
            "fax_number": "708-216-8059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "OUTPATIENT CENTER ROOM 1620",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-9000",
            "fax_number": "708-216-8059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOYOLA UNIVERSITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-18",
        "last_updated": "2015-07-06",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-216-3215",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.