Provider Demographics
NPI:1639224827
Name:OAK SURGICAL INSTITUTE
Entity Type:Organization
Organization Name:OAK SURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-928-9999
Mailing Address - Street 1:403 S KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2152
Mailing Address - Country:US
Mailing Address - Phone:815-928-9999
Mailing Address - Fax:815-928-8669
Practice Address - Street 1:403 S KENNEDY DR
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2152
Practice Address - Country:US
Practice Address - Phone:815-928-9999
Practice Address - Fax:815-928-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002702261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========Medicaid