Provider Demographics
NPI:1194480640
Name:PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Entity type:Organization
Organization Name:PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, NET REVENUE & REIMB
Authorized Official - Prefix:
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKNISKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-213-0776
Mailing Address - Street 1:77 N AIRLITE STREET
Mailing Address - Street 2:DIABETES SERVICES
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4912
Mailing Address - Country:US
Mailing Address - Phone:847-695-3200
Mailing Address - Fax:847-931-5742
Practice Address - Street 1:77 N AIRLITE STREET
Practice Address - Street 2:DIABETES SERVICES
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4912
Practice Address - Country:US
Practice Address - Phone:847-695-3200
Practice Address - Fax:847-931-5742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESENCE CHICAGO HOSPITALS NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-01
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty