Provider Demographics
NPI:1841352788
Name:WEST SUBURBAN UROLOGY, S.C.
Entity type:Organization
Organization Name:WEST SUBURBAN UROLOGY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BELCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-960-1498
Mailing Address - Street 1:3825 HIGHLAND
Mailing Address - Street 2:# 207
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-960-1498
Mailing Address - Fax:630-960-9303
Practice Address - Street 1:3825 HIGHLAND
Practice Address - Street 2:# 207
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-960-1498
Practice Address - Fax:630-960-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042928Medicaid
IL036042928Medicaid