Provider Demographics
NPI:1417036021
Name:SUBURBAN SURGICAL SERVICES
Entity Type:Organization
Organization Name:SUBURBAN SURGICAL SERVICES
Other - Org Name:NORTH SHORE AMBULATORY SERGICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:YUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-550-0040
Mailing Address - Street 1:900 W. ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3416
Mailing Address - Country:US
Mailing Address - Phone:847-550-0040
Mailing Address - Fax:847-784-0045
Practice Address - Street 1:330 W FRONTAGE RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3467
Practice Address - Country:US
Practice Address - Phone:847-550-0040
Practice Address - Fax:847-550-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD61444866261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD61444866OtherCORP