Provider Demographics
NPI:1184638975
Name:SIX CORNERS SAME DAY SURGERY, LLC.
Entity Type:Organization
Organization Name:SIX CORNERS SAME DAY SURGERY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARMED
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-545-6900
Mailing Address - Street 1:4211 N CICERO AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1651
Mailing Address - Country:US
Mailing Address - Phone:773-545-6900
Mailing Address - Fax:773-545-2220
Practice Address - Street 1:4211 N CICERO AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1651
Practice Address - Country:US
Practice Address - Phone:773-545-6900
Practice Address - Fax:773-545-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002645261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00011720OtherMEDICARE RAILROAD
ILP00011720OtherMEDICARE RAILROAD
IL204436Medicare ID - Type UnspecifiedPROVIDER NUMBER