Provider Demographics
NPI:1710924899
Name:DMG SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:DMG SURGICAL CENTER LLC
Other - Org Name:SURGICAL CENTER OF DUPAGE MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT, BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-790-1221
Mailing Address - Street 1:PO BOX 713268
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1268
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:2725 SOUTH TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5675
Practice Address - Country:US
Practice Address - Phone:630-348-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7003023261QA1903X, 261QS0132X, 332B00000X
IL261QA1903X, 261QS0132X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL785110Medicare PIN
IL212950Medicare ID - Type Unspecified