Provider Demographics
NPI:1013076181
Name:WEST SUBURBAN MEDICAL & SURGICAL ASSOCIATES,S.C.
Entity Type:Organization
Organization Name:WEST SUBURBAN MEDICAL & SURGICAL ASSOCIATES,S.C.
Other - Org Name:AURORA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-801-0031
Mailing Address - Street 1:330 WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4767
Mailing Address - Country:US
Mailing Address - Phone:630-801-0031
Mailing Address - Fax:630-801-0199
Practice Address - Street 1:330 WESTON AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4767
Practice Address - Country:US
Practice Address - Phone:630-801-0031
Practice Address - Fax:630-801-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618478174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL042618478OtherILLINOIS REGISTERED MEDIC