Provider Demographics
NPI:1366627721
Name:WOODFIELD SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:WOODFIELD SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CROSSETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:847-605-0280
Mailing Address - Street 1:1701 E WOODFIELD RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5905
Mailing Address - Country:US
Mailing Address - Phone:847-605-0280
Mailing Address - Fax:847-605-0288
Practice Address - Street 1:1701 E WOODFIELD RD
Practice Address - Street 2:SUITE 510
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5905
Practice Address - Country:US
Practice Address - Phone:847-605-0280
Practice Address - Fax:847-605-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QA1903X, 261QA1903X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical