Provider Demographics
NPI:1689884603
Name:LIFE SURGICAL SERVICES INC
Entity Type:Organization
Organization Name:LIFE SURGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:708-799-1910
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:POSEN
Mailing Address - State:IL
Mailing Address - Zip Code:60469-0044
Mailing Address - Country:US
Mailing Address - Phone:708-825-9329
Mailing Address - Fax:708-658-1701
Practice Address - Street 1:1820 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1760
Practice Address - Country:US
Practice Address - Phone:708-825-9329
Practice Address - Fax:708-658-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty