Provider Demographics
NPI:1699407643
Name:SKIN CANCER SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SKIN CANCER SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGINNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-622-7546
Mailing Address - Street 1:331 REGENCY PARK
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1887
Mailing Address - Country:US
Mailing Address - Phone:618-622-7546
Mailing Address - Fax:618-227-0098
Practice Address - Street 1:331 REGENCY PARK
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1887
Practice Address - Country:US
Practice Address - Phone:618-622-7546
Practice Address - Fax:618-227-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical