Provider Demographics
NPI:1962507269
Name:ANN & ROBERT H. LURIE CHILDREN'S HOSPTIAL OF CHICAGO
Entity Type:Organization
Organization Name:ANN & ROBERT H. LURIE CHILDREN'S HOSPTIAL OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-227-4306
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:BOX 44
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-7118
Mailing Address - Fax:312-227-9505
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX 44
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-7118
Practice Address - Fax:312-227-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005843282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========401Medicaid