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General NPI Number Information
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NPI Number | 1700188000
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Entity Type | Organization
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Legal Business Name | ELMHURST MEDICAL & SURGICAL CENTER CORPORATION
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 340 W BUTTERFIELD RD STE 1B
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City | ELMHURST
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State | IL
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Zip | 60126-5047
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Country | US
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Telephone | 630-495-1240
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Fax | 630-495-1993
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Provider Business Mailing Address
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Address Line | 6 E SAINT CHARLES RD STE 100
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City | LOMBARD
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State | IL
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Zip | 60148-2302
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Country | US
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Telephone | 630-495-1240
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Fax | 630-495-1993
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEN GRIMES
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Credential |
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Telephone | 630-495-1240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7003154
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License Number State | IL
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