Provider Demographics
NPI:1801337506
Name:UNIVERSITY OF CHICAGO MEDICAL CENTER
Entity type:Organization
Organization Name:UNIVERSITY OF CHICAGO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:773-702-5486
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC1033
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-5486
Mailing Address - Fax:773-834-3673
Practice Address - Street 1:1122 PAYSPHERE CIR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60674-0011
Practice Address - Country:US
Practice Address - Phone:773-702-6664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0003897282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0003897Medicaid
IL0003897Medicaid