Provider Demographics
NPI:1811167430
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
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:STE L140
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1876
Mailing Address - Country:US
Mailing Address - Phone:708-763-5540
Mailing Address - Fax:708-763-5550
Practice Address - Street 1:1025 PLEASANT PL
Practice Address - Street 2:ANNEX
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3172
Practice Address - Country:US
Practice Address - Phone:708-383-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST SUBURBAN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2008-04-11
Deactivation Date:2008-03-27
Deactivation Code:
Reactivation Date:2008-04-11
Provider Licenses
StateLicense IDTaxonomies
IL207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623162OtherBCBS GRP
IL548570OtherMEDICARE GRP