Provider Demographics
NPI:1396848222
Name:WEST SUBURBAN HEALTH PROVIDERS, INC
Entity Type:Organization
Organization Name:WEST SUBURBAN HEALTH PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-564-6301
Mailing Address - Street 1:2433 N HARLEM AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2031
Mailing Address - Country:US
Mailing Address - Phone:800-974-7362
Mailing Address - Fax:773-745-7493
Practice Address - Street 1:2433 N HARLEM AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-2031
Practice Address - Country:US
Practice Address - Phone:800-974-7362
Practice Address - Fax:773-745-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization