Provider Demographics
NPI:1548024755
Name:PROVIDER SERVICES AT ST BERNARD
Entity type:Organization
Organization Name:PROVIDER SERVICES AT ST BERNARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-962-4210
Mailing Address - Street 1:326 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3146
Mailing Address - Country:US
Mailing Address - Phone:773-962-4044
Mailing Address - Fax:773-962-4480
Practice Address - Street 1:326 W 64TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3146
Practice Address - Country:US
Practice Address - Phone:773-962-4044
Practice Address - Fax:773-962-4480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST BERNARD HOSPITAL & HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty