Provider Demographics
NPI:1558300954
Name:WEST SUBURBAN MULTI-SPECIALTY MEDICAL SERVICES ASSOCIATION SC
Entity Type:Organization
Organization Name:WEST SUBURBAN MULTI-SPECIALTY MEDICAL SERVICES ASSOCIATION SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLINANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-834-1557
Mailing Address - Street 1:386 N YORK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2363
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:386 N YORK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2363
Practice Address - Country:US
Practice Address - Phone:630-834-1557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
732510Medicare PIN
209944Medicare PIN