| Westminster Place | |
|
3200 Grant Street Evanston IL 60201 | |
| (847) 492-4828 | |
| (847) 492-4810 |
| Full Name | Westminster Place |
|---|---|
| Speciality | Clinic/Center |
| Location | 3200 Grant Street, Evanston, Illinois |
| Authorized Official Name and Position | Mark Havrilka (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 8479793904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Westminster Place 8707 Skokie Blvd Ste 400 Skokie IL 60077-2283 Ph: (847) 979-3955 | Westminster Place 3200 Grant Street Evanston IL 60201 Ph: (847) 492-4828 |
| NPI Number | 1033179411 |
|---|---|
| Provider Enumeration Date | 03/28/2006 |
| Last Update Date | 10/14/2022 |
| Medicare PECOS PAC ID | 4486602018 |
|---|---|
| Medicare Enrollment ID | O20050110000981 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033179411 | NPI | - | NPPES |
| 1633224 | Other | IL | BLUE CROSS BLUE SHIELD OF ILLINOIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Peter Loren Jaggard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639148372 PECOS PAC ID: 3779531355 Enrollment ID: I20050412001416 |
| Provider Name | Shara M Frankenfeld |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1063955375 PECOS PAC ID: 9638459282 Enrollment ID: I20161216002097 |
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