Provider Demographics
NPI:1992770903
Name:WEST SUBURBAN NEUROSURGICAL ASSOCIATES, S.C.
Entity type:Organization
Organization Name:WEST SUBURBAN NEUROSURGICAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAULDEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALMEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-655-1229
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-0433
Mailing Address - Country:US
Mailing Address - Phone:630-655-1229
Mailing Address - Fax:630-655-0185
Practice Address - Street 1:700 E OGDEN AVE STE 106
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1283
Practice Address - Country:US
Practice Address - Phone:630-655-1229
Practice Address - Fax:630-655-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD 4922-407-9174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL16-15248OtherBLUE SHIELD PROVIDER
IL16-15248OtherBLUE SHIELD PROVIDER
IL603860Medicare ID - Type Unspecified