Provider Demographics
NPI:1497736409
Name:SURGICAL ASSOCIATES OF NORTHERN ILLINOIS
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF NORTHERN ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-963-3426
Mailing Address - Street 1:2350 N ROCKTON AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-3600
Mailing Address - Country:US
Mailing Address - Phone:815-963-3426
Mailing Address - Fax:815-963-3428
Practice Address - Street 1:2350 N ROCKTON AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3600
Practice Address - Country:US
Practice Address - Phone:815-963-3426
Practice Address - Fax:815-963-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211985Medicare PIN