Provider Demographics
NPI:1578765210
Name:BMI SURGERY SC
Entity Type:Organization
Organization Name:BMI SURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-717-8744
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9524
Mailing Address - Country:US
Mailing Address - Phone:815-717-8744
Mailing Address - Fax:815-717-8339
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-717-8744
Practice Address - Fax:815-717-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077839208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077839Medicaid
IL036111197Medicaid