Provider Demographics
NPI:1619976651
Name:WESTLAKE HOSPITAL
Entity Type:Organization
Organization Name:WESTLAKE HOSPITAL
Other - Org Name:WESTLAKE HOSPITAL INTERVENTIONAL RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-681-3000
Mailing Address - Street 1:520 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6110
Mailing Address - Country:US
Mailing Address - Phone:630-874-2542
Mailing Address - Fax:
Practice Address - Street 1:1225 W LAKE ST
Practice Address - Street 2:WESTLAKE HOSPITAL / RADIOLOGY DEPARTMENT
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4039
Practice Address - Country:US
Practice Address - Phone:708-681-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTLAKE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-20
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207165Medicare PIN