MEDICARE: WEST SUBURBAN HEALTH PROVIDERS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1396848222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SUBURBAN HEALTH PROVIDERS, INC

Provider Business Mailing Address
First Line	:	2433 N HARLEM AVE
Second Line	:	SUITE 300
City	:	CHICAGO
State	:	IL
Zip	:	60707-2031
Country	:	US
Telephone Number	:	800-974-7362
Fax Number	:	773-745-7493

Provider Business Practice Location Address
First Line	:	2433 N HARLEM AVE
Second Line	:	SUITE 300
City	:	CHICAGO
State	:	IL
Zip	:	60707-2031
Country	:	US
Telephone Number	:	800-974-7362
Fax Number	:	773-745-7493

Authorized Official
Title or Position	:	CEO
Name	:	MR. TOD R ERICKSON
Credential	:
Telephone Number	:	773-564-6301

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	03/27/2012

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