Provider Demographics
NPI:1821048786
Name:UNIVERSITY OF CHICAGO
Entity Type:Organization
Organization Name:UNIVERSITY OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER - PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:OSTRANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-834-4508
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:773-702-6400
Mailing Address - Fax:773-702-0000
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:UCPG/MC 1099
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208787Medicare ID - Type UnspecifiedPA GROUP
IN199810Medicare ID - Type Unspecified
IN199860Medicare ID - Type UnspecifiedPHD GROUP
MI0N38370Medicare ID - Type Unspecified
IL621750Medicare ID - Type UnspecifiedLCSW GROUP
IL522600Medicare ID - Type Unspecified
ILCA2169Medicare ID - Type UnspecifiedRAILROAD
IL621530Medicare ID - Type UnspecifiedPHD GROUP
IL703410Medicare ID - Type UnspecifiedAPN GROUP