Provider Demographics
NPI:1649499096
Name:WEST SUBURBAN MEDICAL CENTER
Entity type:Organization
Organization Name:WEST SUBURBAN MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR 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:SUITE L140
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1876
Mailing Address - Country:US
Mailing Address - Phone:708-763-7877
Mailing Address - Fax:708-763-5550
Practice Address - Street 1:52256 EAGLE WAY
Practice Address - Street 2:W SUBURBAN HEALTH CARE PHYSICIANS SVCS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60678-1522
Practice Address - Country:US
Practice Address - Phone:708-763-7877
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:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207VG0400X, 363L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623162OtherBCBS GROUP NUMBER
IL21623162OtherBCBS GROUP NUMBER
IL548570Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER