Provider Demographics
NPI:1033218128
Name:THE UNIVERSITY OF CHICAGO MEDICAL CENTER
Entity Type:Organization
Organization Name:THE UNIVERSITY OF CHICAGO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REVENUE PERFORMANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-702-6890
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:630-667-5073
Mailing Address - Fax:773-702-0148
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-1530
Practice Address - Fax:773-702-8608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF CHICAGO MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1677288282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618898OtherBLUE SHIELD
IL705300Medicare Oscar/Certification
IL1618898OtherBLUE SHIELD
IL209441Medicare Oscar/Certification
IL829300Medicare Oscar/Certification
IL203809Medicare Oscar/Certification