Provider Demographics
NPI:1447446976
Name:WEST SUBURBAN EMERGENCY SERVICES, LLC
Entity type:Organization
Organization Name:WEST SUBURBAN EMERGENCY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BETZELOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-728-5133
Mailing Address - Street 1:5757 N LINCOLN AVE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4714
Mailing Address - Country:US
Mailing Address - Phone:773-728-5133
Mailing Address - Fax:773-728-5134
Practice Address - Street 1:3 ERIE CT
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2519
Practice Address - Country:US
Practice Address - Phone:708-229-9500
Practice Address - Fax:708-229-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE60464Medicare UPIN