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General NPI Number Information
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NPI Number | 1578689063
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Entity Type | Organization
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Legal Business Name | ELMHURST PHYSICIAN HOSPITAL ORGANIZATION LLC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 855 N CHURCH RD
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City | ELMHURST
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State | IL
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Zip | 60126-1005
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Country | US
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Telephone | 630-833-8200
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Fax | 630-993-5619
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Provider Business Mailing Address
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Address Line | 200 N BERTEAU AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2966
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Country | US
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Telephone | 630-833-8200
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Fax | 630-993-5619
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DENISE LOUISE MEYERS
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Credential |
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Telephone | 630-833-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 60019747
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License Number State | IL
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