MEDICARE: NORTHWESTERN MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1891398731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWESTERN MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	NORTHWESTERN MEMORIAL HOSPITAL D/B/A NM LAB
Second Line	:	DEPT 4698
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	DEPT 4698
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122
Country	:	US
Telephone Number	:	131-292-6484
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT, OPERATIONS
Name	:	MR. KENNETH HEDLEY
Credential	:
Telephone Number	:	312-926-7322

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	10/31/2025

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