Provider Demographics
NPI:1013191097
Name:VALLEY WEST MEDICAL CENTER, S.C.
Entity Type:Organization
Organization Name:VALLEY WEST MEDICAL CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:630-552-7601
Mailing Address - Street 1:1200 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-1790
Mailing Address - Country:US
Mailing Address - Phone:630-552-7601
Mailing Address - Fax:630-552-9215
Practice Address - Street 1:1200 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-1790
Practice Address - Country:US
Practice Address - Phone:630-552-7601
Practice Address - Fax:630-552-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4722870OtherBLUE CROSS/BLUE SHIELD
IL036061677Medicaid