Provider Demographics
NPI:1578672895
Name:NORTHWESTERN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:NORTHWESTERN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGY CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CUCNS
Authorized Official - Phone:312-926-4032
Mailing Address - Street 1:7350 N OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-4378
Mailing Address - Country:US
Mailing Address - Phone:773-775-7927
Mailing Address - Fax:312-926-1986
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:GALTER 8-138
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-4032
Practice Address - Fax:312-926-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635652OtherBC/BS PROVIDER NUMBER
IL=========Medicare UPIN