Provider Demographics
NPI:1235354713
Name:JOLIET OUTPATIENT CENTER, LLC
Entity Type:Organization
Organization Name:JOLIET OUTPATIENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-730-9888
Mailing Address - Street 1:823 129TH INFANTRY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8346
Mailing Address - Country:US
Mailing Address - Phone:815-730-9888
Mailing Address - Fax:815-741-9868
Practice Address - Street 1:823 129TH INFANTRY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8346
Practice Address - Country:US
Practice Address - Phone:815-730-9888
Practice Address - Fax:815-741-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty