Provider Demographics
NPI:1235234535
Name:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Entity Type:Organization
Organization Name:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP AND CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-227-1520
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:#44
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-7118
Mailing Address - Fax:312-227-9505
Practice Address - Street 1:225 E CHICAGO AVE # 44
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-227-7118
Practice Address - Fax:312-227-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005843261QA1903X, 273R00000X, 282NC2000X, 283XC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No273R00000XHospital UnitsPsychiatric Unit
No283XC2000XHospitalsRehabilitation HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0080OtherBLUE CROSS PROVIDER #
IL=========007Medicaid
IL0080OtherBLUE CROSS PROVIDER #
IL=========407Medicaid