MEDICARE: WEST SUBURBAN MEDICAL CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician	IL
2	207VG0400X	Gynecology Physician	IL
3	363L00000X	Nurse Practitioner	IL
4	207Q00000X	Family Medicine Physician	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21623162	OTHER	IL	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1649499096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SUBURBAN MEDICAL CENTER

Provider Business Mailing Address
First Line	:	7411 LAKE ST
Second Line	:	SUITE L140
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1876
Country	:	US
Telephone Number	:	708-763-7877
Fax Number	:	708-763-5550

Provider Business Practice Location Address
First Line	:	52256 EAGLE WAY
Second Line	:	W SUBURBAN HEALTH CARE PHYSICIANS SVCS
City	:	CHICAGO
State	:	IL
Zip	:	60678-1522
Country	:	US
Telephone Number	:	708-763-7877
Fax Number	:	708-763-5550

Authorized Official
Title or Position	:	SYSTEM DIRECTOR PATIENT FINANCIAL S
Name	:	SUSAN PFISTER
Credential	:
Telephone Number	:	847-813-3716

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	06/18/2008

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Directions to “WEST SUBURBAN MEDICAL CENTER ” Practice Location

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