1235475708 NPI number — WESTLAKE EMERGENCY ROOM PROVIDERS, SC

Table of content: (NPI 1235475708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235475708 NPI number — WESTLAKE EMERGENCY ROOM PROVIDERS, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTLAKE EMERGENCY ROOM PROVIDERS, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235475708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WESTLAKE EMERGENCY ROOM PROVIDERS, SC
Provider Second Line Business Mailing Address:
DEPT 10303, PO BOX 87618
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60680-0618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-472-8800
Provider Business Mailing Address Fax Number:
630-472-9502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WESTLAKE COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
1225 W. LAKE STREET
Provider Business Practice Location Address City Name:
MELROSE PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60160-4039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-681-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WAKIM
Authorized Official First Name:
PIERRE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-472-8800

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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