Provider Demographics
NPI:1457493454
Name:ELMHURST MEMORIAL HEALTHCARE
Entity Type:Organization
Organization Name:ELMHURST MEMORIAL HEALTHCARE
Other - Org Name:ELMHURST CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:331-221-9000
Mailing Address - Street 1:PO BOX 776977
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6977
Mailing Address - Country:US
Mailing Address - Phone:630-946-2961
Mailing Address - Fax:630-545-6010
Practice Address - Street 1:1200 S YORK ST
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:331-221-9000
Practice Address - Fax:331-221-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0398570001OtherDMERC
IL2215149OtherBLUE CROSS BLUE SHIELD
ILCM0811OtherRAILROAD MEDICARE GROUP #
IL0398570007OtherDMERC
IL0398570001OtherDMERC
IL0398570002OtherDMERC
ILCM0811OtherRAILROAD MEDICARE GROUP #
IL0398570002OtherDMERC
IL0398570005OtherDMERC
IL0398570007OtherDMERC