Provider Demographics
NPI:1699247502
Name:NORTHWESTERN MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:NORTHWESTERN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-926-4843
Mailing Address - Street 1:2701 PATRIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8039
Mailing Address - Country:US
Mailing Address - Phone:952-653-2565
Mailing Address - Fax:952-653-2540
Practice Address - Street 1:2701 PATRIOT BLVD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8039
Practice Address - Country:US
Practice Address - Phone:952-653-2565
Practice Address - Fax:952-653-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty