Provider Demographics
NPI:1801038302
Name:CHILDREN'S MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CHILDREN'S MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-880-4302
Mailing Address - Street 1:117 FERSON AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-3505
Mailing Address - Country:US
Mailing Address - Phone:816-807-3883
Mailing Address - Fax:
Practice Address - Street 1:2300 N CHILDRENS PLZ # 18
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty