Provider Demographics
NPI:1497706626
Name:CHICAGO PROSTATE CANCER SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CHICAGO PROSTATE CANCER SURGERY CENTER, LLC
Other - Org Name:DUPAGE MEDICAL GROUP SURGERY CENTER, WESTMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-790-1221
Mailing Address - Street 1:815 PASQUINELLI DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1276
Mailing Address - Country:US
Mailing Address - Phone:630-654-2515
Mailing Address - Fax:630-654-2516
Practice Address - Street 1:815 PASQUINELLI DR
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1276
Practice Address - Country:US
Practice Address - Phone:630-654-2515
Practice Address - Fax:630-654-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical