Healthcare Provider Details

I. General information

NPI: 1841419207
Provider Name (Legal Business Name): WEST SUBURBAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 4063 WOMEN'S HEALTH CENTER
CAROL STREAM IL
60122-0001
US

IV. Provider business mailing address

7411 LAKE ST L140
RIVER FOREST IL
60305-1876
US

V. Phone/Fax

Practice location:
  • Phone: 708-763-5540
  • Fax: 708-763-5550
Mailing address:
  • Phone: 708-763-5540
  • Fax: 708-763-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name: SUSAN PFISTER
Title or Position: SYSTEM DIRECTOF PATIENT FINANCIAL S
Credential:
Phone: 847-813-3716