Provider Demographics
NPI:1902941628
Name:ALEXIAN BROTHERS MEDICAL CENTER
Entity Type:Organization
Organization Name:ALEXIAN BROTHERS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, BUDGET/DECISION
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-590-2555
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:935 BEISNER RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3475
Practice Address - Country:US
Practice Address - Phone:847-640-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALEXIAN BROTHERS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
368OtherBCBS
130748200OtherFED WORKERS COMPENSATION
130748200OtherFED WORKERS COMPENSATION
368OtherBCBS
IL14T258Medicare Oscar/Certification