Provider Demographics
NPI:1144231929
Name:FLOSSMOOR PAIN INSTITUTE AND SURGICAL CARE, LLC
Entity Type:Organization
Organization Name:FLOSSMOOR PAIN INSTITUTE AND SURGICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-464-7212
Mailing Address - Street 1:19550 GOVERNORS HWY
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2125
Mailing Address - Country:US
Mailing Address - Phone:708-922-1902
Mailing Address - Fax:708-922-1825
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 1400
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-922-1902
Practice Address - Fax:708-922-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPOO394804OtherRR MEDICARE
IL1636489OtherBLUE CROSS
ILPOO394804OtherRR MEDICARE
IL=========Medicaid
IL=========Medicaid
IL208192Medicare PIN