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PED143300-12 Ann & Robert H. Lurie Children's Hospital of Chicago (Active)
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Main Details
Name
Ann & Robert H. Lurie Children's Hospital of Chicago
Subdivision Name
LURIE CHILDRENS HOSPITAL OUTPATIENT - 103053 HOSP - CLK/DEM - Urodynamics
Type
Children's Hospital
Rural
No
340B ID
PED143300-12
Medicare Provider Number
143300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/17/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/15/2023
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Ann & Robert H. Lurie Children's Hospital of Chicago
Brian Stahulak, Chief Nursing Officer
(312) 227-4622
Primary Contact
Ann & Robert H Lurie Children's Hospital of Chicago
Jenny Elhadary, VP Clinical Services
(312) 227-4161
Addresses
Street Address
2515 N CLARK ST
CHICAGO, IL 60614-2730
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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