Presence Saint Joseph Hospital

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRESENCE SAINT JOSEPH HOSPITAL

Practice address

711 West North Avenue
Chicago, IL 60610-0000

Phone

(312) 337-1982

Fax

(312) 642-3847

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Melvonne Wickliffe-Jones

Title

Credentialing MGR

Phone

(630) 914-2417

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Saint Joseph Hospital Doing business as

Locations

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1366537953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BOULEVARD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604400000",
            "telephone_number": "630-914-2417",
            "fax_number": "630-914-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 WEST NORTH AVENUE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606100000",
            "telephone_number": "312-337-1982",
            "fax_number": "312-642-3847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE SAINT JOSEPH HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-04-09",
        "status": "A",
        "authorized_official_last_name": "WICKLIFFE-JONES",
        "authorized_official_first_name": "MELVONNE",
        "authorized_official_title_or_position": "CREDENTIALING MGR",
        "authorized_official_telephone_number": "630-914-2417",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD #",
            "identifier": "1633408",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Joseph Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Presence Healthcare Services Presence Medical Group
• Presence Healthccare Services
• Presence Proviso Family Services Inc
• Presence Resurrection Medical Center
• Presence Saint Joseph Hospital
• Presence Saint Joseph Hospital Chicago
• Presence Saints Mary and Elizabeth Medical Center
• Presence Saints Mary and Elizabeth Medical Center
• Presence Senior Services Chicagoland
• Presence St Joseph Hospital

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; 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.