Healthcare Provider Details

I. General information

NPI: 1982928776
Provider Name (Legal Business Name): CHILDRENS MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ #44
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

2300 N CHILDRENS PLZ #44
CHICAGO IL
60614-3363
US

V. Phone/Fax

Practice location:
  • Phone: 312-573-4581
  • Fax: 312-573-4500
Mailing address:
  • Phone: 312-573-4581
  • Fax: 312-573-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. PAULA NOBLE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 312-573-4578