Provider Demographics
NPI:1356707640
Name:WEST ADAMS HEALTH SERVICES INC.
Entity type:Organization
Organization Name:WEST ADAMS HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-382-1030
Mailing Address - Street 1:600 HOLIDAY PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2241
Mailing Address - Country:US
Mailing Address - Phone:708-898-2613
Mailing Address - Fax:
Practice Address - Street 1:600 HOLIDAY PLAZA DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2241
Practice Address - Country:US
Practice Address - Phone:708-898-2613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-03
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty