Provider Demographics
NPI:1891755351
Name:THOREK MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:THOREK MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-975-6705
Mailing Address - Street 1:5025 N PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2772
Mailing Address - Country:US
Mailing Address - Phone:773-271-9040
Mailing Address - Fax:773-271-2010
Practice Address - Street 1:5025 N PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2772
Practice Address - Country:US
Practice Address - Phone:773-271-9040
Practice Address - Fax:773-271-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000125273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362012788001Medicaid
IL362012788002Medicaid
145672Medicare Oscar/Certification
IL812030Medicare Oscar/Certification
140197Medicare Oscar/Certification
IL=========001Medicaid