Provider Demographics
NPI:1558484022
Name:SURGICAL HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SURGICAL HEALTH ASSOCIATES, LLC
Other - Org Name:ALLEN D. BLOOM, MD, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-585-0200
Mailing Address - Street 1:2020 OGDEN AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5895
Mailing Address - Country:US
Mailing Address - Phone:630-585-0200
Mailing Address - Fax:630-585-7396
Practice Address - Street 1:2020 OGDEN AVE STE 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5895
Practice Address - Country:US
Practice Address - Phone:630-585-0200
Practice Address - Fax:630-585-7396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202337Medicare PIN