# SUBURBAN MEDICAL CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164689980
- **Authorized official:** DR. RITESH D PATEL M.D (PRESIDENT)
- **Authorized official phone:** (847) 226-8900

## Contact information

- **Practice address:** 1555 BARRINGTON RD BLDG 3, SUITE \# 2500, HOFFMAN ESTATES, IL 60169-1019
- **Practice address phone:** (847) 226-8900
- **Practice address fax:** (224) 330-1665
- **Mailing address:** PO BOX 967, TINLEY PARK, IL 60477-0967
- **Mailing address phone:** (708) 532-6029
- **Mailing address fax:** (708) 532-6095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 036-115260 | IL | Yes |

## Other

- **Enumeration date:** 05/20/2008
- **Last updated:** 09/18/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0001639510 | BS PROVIDER \# | IL |
| 05 | — | 036115260 | — | IL |
| 01 | — | 216663 | MEDICARE PTAN | IL |