Provider Demographics
NPI:1841419207
Name:WEST SUBURBAN MEDICAL CENTER
Entity Type:Organization
Organization Name:WEST SUBURBAN MEDICAL CENTER
Other - Org Name:WOMENS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOF PATIENT FINANCIAL S
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 LAKE ST
Mailing Address - Street 2: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:BOX 4063 WOMEN'S HEALTH CENTER
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60122-0001
Practice Address - Country:US
Practice Address - Phone:708-763-5540
Practice Address - Fax:708-763-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207VG0400X, 207VX0000X, 363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL803900OtherMEDICARE GRP
IL01621924OtherBCBS GROUP NUMBER
IL207667Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER