Provider Demographics
NPI:1013102086
Name:ELMHURST MEMORIAL HEALTHCARE
Entity Type:Organization
Organization Name:ELMHURST MEMORIAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LURYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-993-5676
Mailing Address - Street 1:130 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2670
Mailing Address - Country:US
Mailing Address - Phone:630-834-1120
Mailing Address - Fax:630-993-5681
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2670
Practice Address - Country:US
Practice Address - Phone:630-834-1120
Practice Address - Fax:630-993-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2215149OtherBLUE CROSS BLUE SHIELD
IL0398570005Medicare NSC
IL2215149OtherBLUE CROSS BLUE SHIELD