Provider Demographics
NPI:1538279518
Name:ANN & ROBERT H LURIE CHILDRENS HOSPITAL OF CHICAGO
Entity Type:Organization
Organization Name:ANN & ROBERT H LURIE CHILDRENS HOSPITAL OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAUSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-573-4578
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:312-573-4581
Mailing Address - Fax:312-573-4500
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:#44
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-573-4581
Practice Address - Fax:312-573-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0003137282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid