1811167430 NPI number — WEST SUBURBAN MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811167430 NPI number — WEST SUBURBAN MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST SUBURBAN MEDICAL CENTER
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:
WEST SUBURBAN CARING CENTER AT MILLS PARK TOWER
Provider Other Organization Name Type Code:
3
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:
1811167430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/27/2008
NPI Reactivation Date:
04/11/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7411 LAKE ST
Provider Second Line Business Mailing Address:
STE L140
Provider Business Mailing Address City Name:
RIVER FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60305-1876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-763-5540
Provider Business Mailing Address Fax Number:
708-763-5550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 PLEASANT PL
Provider Second Line Business Practice Location Address:
ANNEX
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60302-3172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-383-3390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PFISTER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SYSTEM DIRECTOR
Authorized Official Telephone Number:
847-813-3716

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21623162 . This is a "BCBS GRP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 548570 . This is a "MEDICARE GRP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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