Provider Demographics
NPI:1538310172
Name:WEST SUBURBAN MEDICAL CTR.
Entity Type:Organization
Organization Name:WEST SUBURBAN MEDICAL CTR.
Other - Org Name:GARDEN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR, PATIENT FINANCIAL
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 ST
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 1:8333 SOUTH AUSTIN
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2558
Practice Address - Country:US
Practice Address - Phone:708-398-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21623162OtherBCBS GRP
548570Medicare PIN