Provider Demographics
NPI:1194939215
Name:ST. JOSEPH HOSPITAL
Entity type:Organization
Organization Name:ST. JOSEPH HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:STRUXNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-665-3000
Mailing Address - Street 1:1 TRANSAM PLAZA DR.
Mailing Address - Street 2:SUITE 490
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-424-1122
Mailing Address - Fax:630-424-1678
Practice Address - Street 1:2900 N LAKE SHORE DR.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-665-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074319152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632129OtherBCBS OF IL GROUP PROVIDER
IL901650Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER