Provider Demographics
| NPI: | 1215914791 |
|---|---|
| Name: | MERCY HOSPITAL &MEDICAL CENTER |
| Entity type: | Organization |
| Organization Name: | MERCY HOSPITAL &MEDICAL CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP OF FINANCE |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SILIA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MIGLIO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 312-567-2580 |
| Mailing Address - Street 1: | 28231 NETWORK PL |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CHICAGO |
| Mailing Address - State: | IL |
| Mailing Address - Zip Code: | 60673-1282 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 312-567-2118 |
| Mailing Address - Fax: | 312-328-7701 |
| Practice Address - Street 1: | 2525 S MICHIGAN AVE |
| Practice Address - Street 2: | ATT: PHYSICIAN BILLING/CREDENTIALING DEPT |
| Practice Address - City: | CHICAGO |
| Practice Address - State: | IL |
| Practice Address - Zip Code: | 60616-2315 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 312-567-7924 |
| Practice Address - Fax: | 312-567-6189 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-12-27 |
| Last Update Date: | 2022-07-21 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| IL | 101Y00000X, 176B00000X, 207K00000X, 207Q00000X, 207RC0000X, 207RE0101X, 207RG0100X, 207RN0300X, 207V00000X, 207W00000X, 208000000X, 2084P0800X, 208600000X, 207R00000X | |
| 207L00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 176B00000X | Other Service Providers | Midwife | Group - Multi-Specialty | |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IL | 01621679 | Other | BCBS OF IL |
| IL | ========= | Other | TIN # |
| IL | 363720708 | Other | FQHC TIN |
| IL | 950150 | Medicare ID - Type Unspecified |