Provider Demographics
NPI:1720201320
Name:SURGICAL SPECIALISTS, SC
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUMBRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-272-6606
Mailing Address - Street 1:12800 S RIDGELAND AVE
Mailing Address - Street 2:UNIT F
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2390
Mailing Address - Country:US
Mailing Address - Phone:708-272-6606
Mailing Address - Fax:708-272-6620
Practice Address - Street 1:12800 S RIDGELAND AVE
Practice Address - Street 2:UNIT F
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2390
Practice Address - Country:US
Practice Address - Phone:708-272-6606
Practice Address - Fax:708-272-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty