NPIMap

Organization Active NPI

Presence Saints Mary and Elizabeth Medical Center

  • Neurological Surgery Physician
  • Chicago, IL
National Provider Identifier
1811229693
Registry record updated Apr 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
PRESENCE SAINTS MARY AND ELIZABETH MEDICAL CENTER
Practice address
1431 N Western Ave
Suite 306
Chicago, IL 60622-1797
Phone
(312) 332-2226
Fax
(773) 276-1197
NPI assigned
Feb 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2013

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X Primary

Addresses

Primary practice location

1431 N Western Ave
Suite 306
Chicago, IL 60622-1797

Mailing address

1000 Remington Boulevard
Suite 100
Bolingbrook, IL 60440-0000
Phone (630) 914-2417

Other names 1

  • Saints Mary and Elizabeth Medical Center Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
St Mary Nazareth Hosp9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1811229693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BOULEVARD",
            "address_2": "SUITE 100",
            "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": "1431 N WESTERN AVE",
            "address_2": "SUITE 306",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221797",
            "telephone_number": "312-332-2226",
            "fax_number": "773-276-1197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESENCE SAINTS MARY AND ELIZABETH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-04",
        "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": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saints Mary and Elizabeth Medical Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • 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.