Provider Demographics
NPI:1134311251
Name:ELMHURST MEMORIAL HEALTHCARE
Entity Type:Organization
Organization Name:ELMHURST MEMORIAL HEALTHCARE
Other - Org Name:ELMURST CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:630-834-1120
Mailing Address - Street 1:172 SCHILLER ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2816
Mailing Address - Country:US
Mailing Address - Phone:630-834-1120
Mailing Address - Fax:630-993-5681
Practice Address - Street 1:471 W ARMY TRAIL ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2673
Practice Address - Country:US
Practice Address - Phone:630-671-8020
Practice Address - Fax:630-671-8021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELMHURST MEMORIAL HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-13
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2215149OtherBCBS OF IL
IL610600Medicare PIN
IL0398570006Medicare NSC
0398570006Medicare NSC