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RRC140223-22 ADVOCATE LUTHERAN GENERAL HOSPITAL (Terminated)
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Main Details
Name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Subdivision Name
Radiology - Therapeutic - CAC Cyberknife
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140223-22
Medicare Provider Number
140223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/13/2020
Last Recertification Date
9/8/2020
Termination Date
Termination Reason
1/1/2021
Site closure
Contacts
Authorizing Official
Advocate Aurora Health Care
Nan Nelson, SVP-Finance
(414) 378-4765
Primary Contact
Advocate Aurora Health Care
Angela De Ianni, Vice President Pharmacy Supply Chain
(414) 630-1541
Addresses
Street Address
1700 Luther Lane
Park Ridge, IL 60068
Billing Address
Advocate Lutheran General Hospital
1775 W. Dempster Street
Park Ridge, IL 60068
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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