Provider Demographics
NPI:1508064957
Name:MOON'S REGIONAL MEDICAL CENTER, S.C.
Entity Type:Organization
Organization Name:MOON'S REGIONAL MEDICAL CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOOK
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-513-5457
Mailing Address - Street 1:270 E. CENTER DR.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1564
Mailing Address - Country:US
Mailing Address - Phone:224-513-5457
Mailing Address - Fax:224-513-5458
Practice Address - Street 1:270 E. CENTER DR.
Practice Address - Street 2:SUITE 120
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1564
Practice Address - Country:US
Practice Address - Phone:224-513-5457
Practice Address - Fax:224-513-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical