Basic Information
| Provider Information | |||||||||
| NPI: | 1417619412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWESTERN MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 676 NORTH SAINT CLAIRE STREET | ||||||||
| Address2: | ARKES FAMILY PAVILION SUITE 560 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129262000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 676 NORTH SAINT CLAIRE STREET | ||||||||
| Address2: | ARKES FAMILY PAVILION SUITE 560 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129262000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2021 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ORSINI | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT & FINANCIAL OFFIC | ||||||||
| AuthorizedOfficialTelephone: | 3129267705 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336S0011X | Y | Suppliers | Pharmacy | Specialty Pharmacy |
No ID Information.