Provider Demographics
NPI:1376720383
Name:MIDWEST SURGICAL CENTER
Entity Type:Organization
Organization Name:MIDWEST SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRUPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-356-3736
Mailing Address - Street 1:2125 S NEIL ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7266
Mailing Address - Country:US
Mailing Address - Phone:217-356-3736
Mailing Address - Fax:217-356-5849
Practice Address - Street 1:2125 S NEIL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7266
Practice Address - Country:US
Practice Address - Phone:217-356-3736
Practice Address - Fax:217-356-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical