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	207VX0000X	Obstetrics Physician	IL
2	363LW0102X	Women's Health Nurse Practitioner	IL
3	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	IL
4	207VG0400X	Gynecology Physician	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	803900	OTHER	IL	MEDICARE GRP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01621924	OTHER	IL	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1841419207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SUBURBAN MEDICAL CENTER

Provider Business Mailing Address
First Line	:	7411 LAKE ST
Second Line	:	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	:	BOX 4063 WOMEN'S HEALTH CENTER
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-0001
Country	:	US
Telephone Number	:	708-763-5540
Fax Number	:	708-763-5550

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	03/20/2008

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Practice Location Address:

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Directions to “WEST SUBURBAN MEDICAL CENTER ” Practice Location

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