MEDICARE: WESTSIDE COMMUNITY HOSPITAL 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	282N00000X	General Acute Care Hospital		IL

General Provider Information

NPI Number	:	1558367656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE COMMUNITY HOSPITAL INC.

Provider Business Mailing Address
First Line	:	3240 W. FRANKLIN BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624
Country	:	US
Telephone Number	:	773-722-3020
Fax Number	:	773-265-7361

Provider Business Practice Location Address
First Line	:	3240 W. FRANKLIN BLVD.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624
Country	:	US
Telephone Number	:	773-722-3020
Fax Number	:	773-265-7361

Authorized Official
Title or Position	:	VP OF FINANCE-CFO
Name	:	MR. ROY PAYAWAL
Credential	:	CPA
Telephone Number	:	773-265-7626

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	04/04/2013

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