Provider Demographics
NPI:1114078060
Name:NAPERVILLE SURGICAL CENTRE LLC
Entity Type:Organization
Organization Name:NAPERVILLE SURGICAL CENTRE LLC
Other - Org Name:ANESTHESIA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:LADNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-869-6395
Mailing Address - Street 1:1263 RICKERT DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-0954
Mailing Address - Country:US
Mailing Address - Phone:630-305-3300
Mailing Address - Fax:630-305-3301
Practice Address - Street 1:1263 RICKERT DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0954
Practice Address - Country:US
Practice Address - Phone:630-305-3300
Practice Address - Fax:630-305-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7003205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDB5335OtherRAILROAD MEDICARE
IL207924Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER