Healthcare Provider Details

I. General information

NPI: 1053417295
Provider Name (Legal Business Name): NORTHWESTERN MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone: 312-926-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number2000685
License Number StateIL

VIII. Authorized Official

Name: MR. DOUGLAS M. YOUNG
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 312-926-6953