Provider Demographics
NPI:1508113580
Name:VERMILION COUNTY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:VERMILION COUNTY SURGERY CENTER, LLC
Other - Org Name:ACCESS AMBULATORY CARE CENTER FOR EXCELLENCE IN SURGICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-443-5201
Mailing Address - Street 1:26 W WEST NEWELL RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-7488
Mailing Address - Country:US
Mailing Address - Phone:217-446-1400
Mailing Address - Fax:217-446-5907
Practice Address - Street 1:26 W WEST NEWELL RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61834-7488
Practice Address - Country:US
Practice Address - Phone:217-446-1400
Practice Address - Fax:217-446-5907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROVENA HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002363261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558467936OtherNPI NUMBER
141084OtherMEDICARE PTAN