Healthcare Provider Details

I. General information

NPI: 1013191097
Provider Name (Legal Business Name): VALLEY WEST MEDICAL CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W SOUTH ST
PLANO IL
60545-1790
US

IV. Provider business mailing address

1200 W SOUTH ST
PLANO IL
60545-1790
US

V. Phone/Fax

Practice location:
  • Phone: 630-552-7601
  • Fax: 630-552-9215
Mailing address:
  • Phone: 630-552-7601
  • Fax: 630-552-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE G. TREVINO SR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-552-7601