Provider Demographics
NPI:1639668726
Name:ELMHURST ORTHOPAEDIC SURGICAL FACILITY, LLC
Entity Type:Organization
Organization Name:ELMHURST ORTHOPAEDIC SURGICAL FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-834-0491
Mailing Address - Street 1:300 W BUTTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5017
Mailing Address - Country:US
Mailing Address - Phone:630-834-0491
Mailing Address - Fax:630-834-0735
Practice Address - Street 1:300 W BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5017
Practice Address - Country:US
Practice Address - Phone:630-834-0491
Practice Address - Fax:630-834-0735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELMHURST ORTHOPAEDICS, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherFEIN