Provider Demographics
NPI:1790257004
Name:CHILDREN'S HOSPITAL OF CHICAGO MEDICAL CENTER
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF CHICAGO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAUSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-227-7133
Mailing Address - Street 1:225 E CHICAGO AVE # 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-7707
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE # 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL OF CHICAGO MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management