Provider Demographics
NPI:1629003165
Name:COPLEY MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:COPLEY MEMORIAL HOSPITAL INC.
Other - Org Name:RUSH-COPLEY FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-978-6200
Mailing Address - Street 1:2020 OGDEN AVE
Mailing Address - Street 2:SUTIE 330
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5894
Mailing Address - Country:US
Mailing Address - Phone:630-978-4580
Mailing Address - Fax:630-978-6865
Practice Address - Street 1:2020 OGDEN AVE
Practice Address - Street 2:SUTIE 330
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5894
Practice Address - Country:US
Practice Address - Phone:630-978-4580
Practice Address - Fax:630-978-6865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPLEY MEMORIAL HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL638460OtherMEDICARE GROUP NUMBER