Provider Demographics
NPI:1760421705
Name:BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Entity Type:Organization
Organization Name:BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Other - Org Name:UNIVERSITY OF ILLINOIS MEDICAL CENTER AT CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CFO, COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:K
Authorized Official - Last Name:KNORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-996-8800
Mailing Address - Street 1:809 S MARSHFIELD AVE
Mailing Address - Street 2:9TH FLOOR (M/C 732)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4305
Mailing Address - Country:US
Mailing Address - Phone:312-996-1000
Mailing Address - Fax:312-996-1001
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-7699
Practice Address - Fax:312-996-1001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0582290001Medicare NSC