Provider Demographics
NPI:1932819505
Name:WEST SUBURBAN CTR FOR ARTHRITIS
Entity type:Organization
Organization Name:WEST SUBURBAN CTR FOR ARTHRITIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-785-1964
Mailing Address - Street 1:601 N BARKER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5929
Mailing Address - Country:US
Mailing Address - Phone:262-785-1964
Mailing Address - Fax:262-785-8029
Practice Address - Street 1:601 N BARKER RD STE 110
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5929
Practice Address - Country:US
Practice Address - Phone:262-785-1964
Practice Address - Fax:262-785-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32805700Medicaid