NPIMap

Organization Active NPI

Loyola University Medical Center

Doing business as Loyola Outpatient Center

  • Community/Retail Pharmacy
  • Maywood, IL
National Provider Identifier
1104462126
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
LOYOLA UNIVERSITY MEDICAL CENTER
Doing business as
Loyola Outpatient Center
Practice address
2160 S 1St Ave RM 150-1610
Maywood, IL 60153-3328
Phone
(708) 216-3743
NPI assigned
Nov 25, 2019
Last updated
Nov 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
LOYOLA UNIVERSITY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

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

Authorized official

Name
Adenrele Adekunbi Kolawole
Title
Director Billing Operations
Phone
(708) 216-3743

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

2160 S 1St Ave RM 150-1610
Maywood, IL 60153-3328

Mailing address

2160 S 1St Ave
Maywood, IL 60153-3328
Phone (708) 216-3743

Other names 1

  • Loyola Outpatient Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211201001376 IL DME Supplier - Pharmacy 3779488903 Practice locations: Maywood, IL

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Loyola University Medic15 organizations share this tax ID, including this one
Part of
Loyola University Medic

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Member of 1

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

Locations

2160 S 1st Ave
Rm 1501610
Maywood, IL 60153
Phone (708) 216-3743

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
RML Specialty HospitalHinsdale, IL, CCN 142010 Hospital Limited Partnership Interest (49.5%) Aug 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574640000000",
    "number": "1104462126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-3743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE RM 150-1610",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-3743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOYOLA UNIVERSITY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOYOLA UNIVERSITY MEDICAL CENTER",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A",
        "authorized_official_last_name": "KOLAWOLE",
        "authorized_official_first_name": "ADENRELE",
        "authorized_official_middle_name": "ADEKUNBI",
        "authorized_official_title_or_position": "DIRECTOR BILLING OPERATIONS",
        "authorized_official_telephone_number": "708-216-3743"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loyola Outpatient Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.