State Hospital of Illinois

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

ILHOS1 Issued in IL

Legal business name

STATE HOSPITAL OF ILLINOIS

Practice address

8461 Walredon Ave
Burr Ridge, IL 60527-6351

Phone

(630) 227-4098

NPI assigned

Dec 12, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Doc Walker, M.D.

Title

President

Phone

(630) 227-4098

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1229040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229040000000",
    "number": "1376788810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8461 WALREDON AVE",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276351",
            "telephone_number": "630-227-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8461 WALREDON AVE",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276351",
            "telephone_number": "630-227-4098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE HOSPITAL OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-12",
        "last_updated": "2008-12-12",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "DOC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-227-4098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "ILHOS1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; 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.