Provider Demographics
NPI:1285695544
Name:COUNTRYVIEW MEDICAL CENTER SC
Entity type:Organization
Organization Name:COUNTRYVIEW MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERNHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-482-9700
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-0700
Mailing Address - Country:US
Mailing Address - Phone:708-482-9700
Mailing Address - Fax:708-482-0217
Practice Address - Street 1:6555 S WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-482-9700
Practice Address - Fax:708-482-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623046OtherBCBS PROVIDER #
IL01623046OtherBCBS PROVIDER #