Provider Demographics
NPI:1851636278
Name:SW MEDICAL CONSULTANTS INC
Entity Type:Organization
Organization Name:SW MEDICAL CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:708-425-4662
Mailing Address - Street 1:6400 W COLLEGE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1900
Mailing Address - Country:US
Mailing Address - Phone:708-389-3224
Mailing Address - Fax:708-425-4692
Practice Address - Street 1:6400 W COLLEGE DR STE 600
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1900
Practice Address - Country:US
Practice Address - Phone:708-425-4662
Practice Address - Fax:708-425-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108097Medicaid
ILH80910Medicare UPIN