Provider Demographics
NPI:1477961324
Name:APOLLO SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:APOLLO SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGEWATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-255-7400
Mailing Address - Street 1:2750 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4103
Mailing Address - Country:US
Mailing Address - Phone:847-255-7400
Mailing Address - Fax:
Practice Address - Street 1:1640 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3985
Practice Address - Country:US
Practice Address - Phone:847-255-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7003166261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical