Provider Demographics
NPI:1700801966
Name:WEST SUBURBAN MEDICAL CENTER
Entity Type:Organization
Organization Name:WEST SUBURBAN MEDICAL CENTER
Other - Org Name:FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
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 L 140 WEST SUBURBAN HEALTH CARE MEDICAL GROUP
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1888
Mailing Address - Country:US
Mailing Address - Phone:708-763-7877
Mailing Address - Fax:708-763-5550
Practice Address - Street 1:1 ERIE COURT
Practice Address - Street 2:STE 6160
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:708-488-1490
Practice Address - Fax:708-488-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623162OtherBCBS GRP
IL548570OtherMEDICARE GROUP NUMBER