Provider Demographics
NPI:1700188000
Name:ELMHURST MEDICAL & SURGICAL CENTER CORPORATION
Entity Type:Organization
Organization Name:ELMHURST MEDICAL & SURGICAL CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-495-1240
Mailing Address - Street 1:6 E SAINT CHARLES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2302
Mailing Address - Country:US
Mailing Address - Phone:630-495-1240
Mailing Address - Fax:630-495-1993
Practice Address - Street 1:340 W BUTTERFIELD RD STE 1B
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5047
Practice Address - Country:US
Practice Address - Phone:630-495-1240
Practice Address - Fax:630-495-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7003154261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14C0001151OtherCMS CERTIFICATION NUMBER