Provider Demographics
NPI:1427179639
Name:SOUTHWEST SURGICAL EXCELLENCE
Entity Type:Organization
Organization Name:SOUTHWEST SURGICAL EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-388-5500
Mailing Address - Street 1:PO BOX 388387
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-8387
Mailing Address - Country:US
Mailing Address - Phone:708-226-7000
Mailing Address - Fax:708-388-5672
Practice Address - Street 1:17495 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-7581
Practice Address - Country:US
Practice Address - Phone:708-226-7000
Practice Address - Fax:708-388-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical