Provider Demographics
NPI:1124210240
Name:ELMHURST MEMORIAL HEALTHCARE
Entity Type:Organization
Organization Name:ELMHURST MEMORIAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LURYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:331-221-9053
Mailing Address - Street 1:172 SCHILLER
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2885
Mailing Address - Country:US
Mailing Address - Phone:331-221-9053
Mailing Address - Fax:630-958-9940
Practice Address - Street 1:1200 S YORK RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:630-758-8371
Practice Address - Fax:630-758-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2215149OtherBCBS OF IL
IL2215149OtherBCBS OF IL
IL0398570002Medicare NSC
IL215281Medicare PIN