Provider Demographics
NPI:1508464074
Name:METRO NORTH SURGICAL CENTER
Entity Type:Organization
Organization Name:METRO NORTH SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDENELZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-217-6052
Mailing Address - Street 1:106 N KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3108
Mailing Address - Country:US
Mailing Address - Phone:920-217-6052
Mailing Address - Fax:
Practice Address - Street 1:2651 N LARAMIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1613
Practice Address - Country:US
Practice Address - Phone:920-217-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO NORTH SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical