| South Shore Hospital Corporation | |
|
8012 S Crandon Ave Chicago IL 60617-1124 | |
| (773) 356-5000 | |
| (773) 768-8154 |
| Full Name | South Shore Hospital Corporation |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 8012 S Crandon Ave, Chicago, Illinois |
| Authorized Official Name and Position | Timothy Arthur Caveney (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7733565312 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Shore Hospital Corporation 8012 S Crandon Ave Chicago IL 60617-1124 Ph: (773) 356-5000 | South Shore Hospital Corporation 8012 S Crandon Ave Chicago IL 60617-1124 Ph: (773) 356-5000 |
| NPI Number | 1689935397 |
|---|---|
| Provider Enumeration Date | 05/30/2012 |
| Last Update Date | 08/15/2012 |
| Medicare PECOS PAC ID | 2264322650 |
|---|---|
| Medicare Enrollment ID | O20120815000214 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689935397 | NPI | - | NPPES |
| 510204952001 | Medicaid | IL | |
| 510204952401 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 2065105 (Illinois) | Primary |
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