Provider Demographics
NPI:1407251622
Name:MASSAC COUNTY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MASSAC COUNTY SURGERY CENTER LLC
Other - Org Name:THE ORTHOPAEDIC INSTITUTE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-309-6005
Mailing Address - Street 1:600 S CLIFF AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5355
Mailing Address - Country:US
Mailing Address - Phone:605-444-8207
Mailing Address - Fax:
Practice Address - Street 1:1811 E 5TH ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960
Practice Address - Country:US
Practice Address - Phone:618-309-6000
Practice Address - Fax:618-309-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical