MEDICARE: WEST SUBURBAN MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207P00000X	Emergency Medicine Physician	IL
2	207Q00000X	Family Medicine Physician	IL
3	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	IL
4	207R00000X	Internal Medicine Physician	IL
5	207RC0000X	Cardiovascular Disease Physician	IL
6	207RH0003X	Hematology & Oncology Physician	IL
7	207RI0200X	Infectious Disease Physician	IL
8	207RR0500X	Rheumatology Physician	IL
9	207VX0201X	Gynecologic Oncology Physician	IL
10	2085R0001X	Radiation Oncology Physician	IL
11	208600000X	Surgery Physician	IL
12	208D00000X	General Practice Physician	IL
13	213E00000X	Podiatrist
14	207ND0900X	Dermatopathology Physician	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1617031	OTHER	IL	BLUE CROSS BLUE SHIELD
2	1620469	OTHER	IL	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1598987091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SUBURBAN MEDICAL CENTER

Provider Business Mailing Address
First Line	:	7411 LAKE ST
Second Line	:	L140
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1876
Country	:	US
Telephone Number	:	708-763-5531
Fax Number	:	708-763-5550

Provider Business Practice Location Address
First Line	:	35001 EAGLE WAY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60678-1350
Country	:	US
Telephone Number	:	708-763-1471
Fax Number	:	708-763-1471

Authorized Official
Title or Position	:	SYSTEM DIRECTOR PATIENT FINANCIAL S
Name	:	SUSAN PFISTER
Credential	:
Telephone Number	:	847-813-3716

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	09/25/2008

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