Healthcare Provider Details

I. General information

NPI: 1982643961
Provider Name (Legal Business Name): THOREK MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W IRVING PARK RD
CHICAGO IL
60613-3077
US

IV. Provider business mailing address

850 W IRVING PARK RD
CHICAGO IL
60613-3077
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-6780
  • Fax: 773-975-3220
Mailing address:
  • Phone: 773-525-6780
  • Fax: 773-975-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0005371
License Number StateIL

VIII. Authorized Official

Name: EDWARD BUDD
Title or Position: CEO
Credential:
Phone: 773-975-6705