Provider Demographics
NPI:1104028109
Name:ROGERS PARK ONE DAY SURGERY CENTER, INC
Entity Type:Organization
Organization Name:ROGERS PARK ONE DAY SURGERY CENTER, INC
Other - Org Name:ROGERS PARK SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-761-0500
Mailing Address - Street 1:7616 N PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1018
Mailing Address - Country:US
Mailing Address - Phone:773-761-0500
Mailing Address - Fax:815-834-1305
Practice Address - Street 1:7616 N PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1018
Practice Address - Country:US
Practice Address - Phone:773-761-0500
Practice Address - Fax:815-834-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical