Provider Demographics
NPI:1316009194
Name:ADVOCATE SOUTHWEST AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ADVOCATE SOUTHWEST AMBULATORY SURGERY CENTER LLC
Other - Org Name:TINLEY WOODS SURGERY CENTER
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:630-852-9300
Mailing Address - Street 1:18200 S. LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487
Mailing Address - Country:US
Mailing Address - Phone:708-570-2490
Mailing Address - Fax:708-570-2499
Practice Address - Street 1:18200 S. LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487
Practice Address - Country:US
Practice Address - Phone:708-570-2490
Practice Address - Fax:708-570-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002652261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL490005727OtherMEDICARE RAILROAD PROV #
IL204797Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER