Provider Demographics
NPI:1124059043
Name:WESTMORELAND OBSTETRIC & GYNECOLOGIC ASSOCIATES, S.C.
Entity type:Organization
Organization Name:WESTMORELAND OBSTETRIC & GYNECOLOGIC ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-234-9110
Mailing Address - Street 1:900 N WESTMORELAND RD
Mailing Address - Street 2:#207
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-234-9110
Mailing Address - Fax:847-234-0900
Practice Address - Street 1:900 WESTMORELAND RD
Practice Address - Street 2:SUITE #207
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1689
Practice Address - Country:US
Practice Address - Phone:847-234-9110
Practice Address - Fax:847-234-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL661170Medicare PIN
IL661170Medicare PIN