Provider Demographics
NPI:1821430513
Name:CENTRAL DU PAGE HOSPITAL ASSN
Entity Type:Organization
Organization Name:CENTRAL DU PAGE HOSPITAL ASSN
Other - Org Name:NW MEDICINE CONVENIENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-208-4172
Mailing Address - Street 1:6501 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3248
Mailing Address - Country:US
Mailing Address - Phone:952-653-2525
Mailing Address - Fax:
Practice Address - Street 1:2635 CHURCH RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502
Practice Address - Country:US
Practice Address - Phone:952-653-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL DU PAGE HOSPITAL ASSN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-23
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site