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NPI Code Detail

MEDICARE: WEST SUBURBAN MEDICAL CTR.

MEDICARE: WEST SUBURBAN MEDICAL CTR.
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121623162OTHERBCBS GRP

General Provider Information

NPI Number : 1538310172
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST SUBURBAN MEDICAL CTR.
Provider Business Mailing Address
First Line : 7411 W LAKE ST
Second Line : STE L140
City : RIVER FOREST
State : IL
Zip : 60305-1876
Country : US
Telephone Number : 708-763-5540
Fax Number : 708-763-5550
Provider Business Practice Location Address
First Line : 8333 SOUTH AUSTIN
Second Line :
City : BURBANK
State : IL
Zip : 60459-2558
Country : US
Telephone Number : 708-398-6550
Fax Number :
Authorized Official
Title or Position : SYSTEM DIRECTOR, PATIENT FINANCIAL
Name : SUSAN PFISTER
Credential :
Telephone Number : 847-813-3716
Provider Enumeration Date : 10/01/2008
Last Update Date : 10/01/2008

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Directions to “WEST SUBURBAN MEDICAL CTR. ” Practice Location

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