Provider Demographics
NPI:1790710390
Name:SOUTHWESTERN MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHWESTERN MEDICAL CENTER, LLC
Other - Org Name:MAGNA SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZORGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-445-9696
Mailing Address - Street 1:PO BOX 88724
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-8724
Mailing Address - Country:US
Mailing Address - Phone:773-445-9696
Mailing Address - Fax:773-445-9590
Practice Address - Street 1:7456 S STATE RD, STE 300
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60638-6621
Practice Address - Country:US
Practice Address - Phone:773-445-9696
Practice Address - Fax:773-445-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QA1903X
IL7002264261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141086Medicare UPIN