Provider Demographics
NPI:1134266612
Name:WESTCHESTER INTEGRATED HEALTH CARE SC
Entity type:Organization
Organization Name:WESTCHESTER INTEGRATED HEALTH CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-343-2657
Mailing Address - Street 1:PO BOX 5379
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-5379
Mailing Address - Country:US
Mailing Address - Phone:708-343-2657
Mailing Address - Fax:708-343-2793
Practice Address - Street 1:10001 W ROOSEVELT RD
Practice Address - Street 2:SUITE 304
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2664
Practice Address - Country:US
Practice Address - Phone:708-343-2657
Practice Address - Fax:708-343-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC51327Medicare UPIN
ILK25735Medicare ID - Type UnspecifiedMEMBER NUMBER
IL213148Medicare PIN