Provider Demographics
NPI:1689734071
Name:SOUTH CHICAGO SURGICAL SOLUTIONS
Entity Type:Organization
Organization Name:SOUTH CHICAGO SURGICAL SOLUTIONS
Other - Org Name:ORLAND SURGICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RHODE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:708-337-7704
Mailing Address - Street 1:16450 S 104TH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-364-8441
Mailing Address - Fax:708-364-8443
Practice Address - Street 1:16450 104TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5441
Practice Address - Country:US
Practice Address - Phone:708-364-8441
Practice Address - Fax:708-364-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL422700261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical