Healthcare Provider Details

I. General information

NPI: 1225073984
Provider Name (Legal Business Name): WEST SUBURBAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 CENTRAL AVENUE
RIVER FOREST IL
60305-1800
US

IV. Provider business mailing address

7411 LAKE ST STE L140
RIVER FOREST IL
60305-1888
US

V. Phone/Fax

Practice location:
  • Phone: 708-763-2700
  • Fax: 708-763-2781
Mailing address:
  • Phone: 708-763-5531
  • Fax: 708-763-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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