Provider Demographics
NPI:1982883385
Name:NORTH SUBURBAN MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH SUBURBAN MEDICAL CENTER
Other - Org Name:PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTORY OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:E-J
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:303-450-4417
Mailing Address - Street 1:9191 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4361
Mailing Address - Country:US
Mailing Address - Phone:303-450-4417
Mailing Address - Fax:303-450-3543
Practice Address - Street 1:9191 GRANT ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4361
Practice Address - Country:US
Practice Address - Phone:303-450-4417
Practice Address - Fax:303-450-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1190000006282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1821042979Medicare PIN