Provider Demographics
NPI:1467652669
Name:NORTHWEST COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:NORTHWEST COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-618-5017
Mailing Address - Street 1:3060 W SALT CREEK LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5026
Mailing Address - Country:US
Mailing Address - Phone:847-618-4604
Mailing Address - Fax:847-618-4630
Practice Address - Street 1:800 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-618-1000
Practice Address - Fax:847-618-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001701208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619001OtherBLUE SHIELD
IL707310Medicare ID - Type UnspecifiedWPS LAKE COUNTY
IL805800Medicare ID - Type UnspecifiedWPS COOK COUNTY