Provider Demographics
NPI:1366787012
Name:SMG SOUTH STATE HEALTH CENTER
Entity type:Organization
Organization Name:SMG SOUTH STATE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-257-2664
Mailing Address - Street 1:5050 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-5302
Mailing Address - Country:US
Mailing Address - Phone:773-257-1110
Mailing Address - Fax:
Practice Address - Street 1:5050 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-5302
Practice Address - Country:US
Practice Address - Phone:773-257-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT SINAI COMMUNITY FOUNDATION DBA SINIA MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty