Provider Demographics
NPI:1467622019
Name:WEST SUBURBAN MEDICAL CENTER
Entity Type:Organization
Organization Name:WEST SUBURBAN MEDICAL CENTER
Other - Org Name:OAK LEYDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PFISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-813-3716
Mailing Address - Street 1:7411 W LAKE STREET
Mailing Address - Street 2:STE L140
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1876
Mailing Address - Country:US
Mailing Address - Phone:708-763-5540
Mailing Address - Fax:708-763-5550
Practice Address - Street 1:411 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2233
Practice Address - Country:US
Practice Address - Phone:708-524-1050
Practice Address - Fax:708-524-2469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST SUBURBAN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL548570OtherMEDICARE GRP
IL21623162OtherBCBS GRP