Provider Demographics
NPI:1548445422
Name:THE PALOS HILLS MEDICAL CENTER, S.C.
Entity type:Organization
Organization Name:THE PALOS HILLS MEDICAL CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:REVETHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-599-3100
Mailing Address - Street 1:10400 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1972
Mailing Address - Country:US
Mailing Address - Phone:708-599-3100
Mailing Address - Fax:708-599-3143
Practice Address - Street 1:10400 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1972
Practice Address - Country:US
Practice Address - Phone:708-599-3100
Practice Address - Fax:708-599-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCB1569OtherRAILROAD MEDICARE
IL1617966OtherBCBS