Provider Demographics
NPI:1336462746
Name:SUBURBAN SURGICAL SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:SUBURBAN SURGICAL SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-420-1009
Mailing Address - Street 1:1585 BARRINGTON RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1090
Mailing Address - Country:US
Mailing Address - Phone:847-892-0234
Mailing Address - Fax:847-892-0237
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:SUITE 501
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1090
Practice Address - Country:US
Practice Address - Phone:847-892-0234
Practice Address - Fax:847-892-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098055208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K18274Medicare PIN
H27527Medicare UPIN