Provider Demographics
NPI:1295381572
Name:SOUTH SUBURBAN SURGICAL SUITES, LLC
Entity Type:Organization
Organization Name:SOUTH SUBURBAN SURGICAL SUITES, LLC
Other - Org Name:SOUTH SUBURBAN SURGICAL SUITES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VELJOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-595-0601
Mailing Address - Street 1:9200 CALUMET AVE STE E-100
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2885
Mailing Address - Country:US
Mailing Address - Phone:219-595-0601
Mailing Address - Fax:219-595-0616
Practice Address - Street 1:9200 CALUMET AVE STE E-100
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2885
Practice Address - Country:US
Practice Address - Phone:708-275-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical