Basic Information
| Provider Information | |||||||||
| NPI: | 1467057513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST COMMUNITY HEALTH SERVICES INC | ||||||||
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| OtherOrganizationName: | NORTHWEST ADVANCED WOMEN'S HEALTHCARE AT NCH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3040 W SALT CREEK LN | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600051069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476183481 | ||||||||
| FaxNumber: | 8476183489 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 W CENTRAL RD STE 6200 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600052378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476180730 | ||||||||
| FaxNumber: | 8476180799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2020 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | HARTKE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8476185004 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 367A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207VX0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.