Provider Demographics
NPI:1568407211
Name:MEDICAL & SURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:MEDICAL & SURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WELTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-343-2262
Mailing Address - Street 1:834 N SEMINARY ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2852
Mailing Address - Country:US
Mailing Address - Phone:309-343-2262
Mailing Address - Fax:309-343-2081
Practice Address - Street 1:834 N SEMINARY ST
Practice Address - Street 2:SUITE 502
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2852
Practice Address - Country:US
Practice Address - Phone:309-343-2262
Practice Address - Fax:309-343-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065538174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208896Medicare ID - Type UnspecifiedMATT BAKER PA-C
IL577520Medicare ID - Type UnspecifiedMAZUR,MCCLEAN,PATTERSON
ILC38461Medicare UPIN
ILB02982Medicare UPIN
ILQ14650Medicare UPIN
6474380001Medicare NSC
ILD42983Medicare UPIN