Provider Demographics
NPI:1710615869
Name:ORTHOILLINOIS SURGERY CENTER ELGIN, LLC
Entity Type:Organization
Organization Name:ORTHOILLINOIS SURGERY CENTER ELGIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CREDENTIALING AND RISK
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:815-381-7431
Mailing Address - Street 1:5875 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-4937
Mailing Address - Country:US
Mailing Address - Phone:815-381-7431
Mailing Address - Fax:
Practice Address - Street 1:2440 ALFT LANE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124
Practice Address - Country:US
Practice Address - Phone:815-398-9491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical