Provider Demographics
NPI:1043429277
Name:KEYSTONE SURGICARE INC
Entity Type:Organization
Organization Name:KEYSTONE SURGICARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-799-1144
Mailing Address - Street 1:3330 W 177TH ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2184
Mailing Address - Country:US
Mailing Address - Phone:708-799-1144
Mailing Address - Fax:
Practice Address - Street 1:3330 W 177TH ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2184
Practice Address - Country:US
Practice Address - Phone:708-799-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical