Provider Demographics
NPI:1730482944
Name:ST IGNATIUS SURGICAL SERVICES LLC
Entity Type:Organization
Organization Name:ST IGNATIUS SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-957-0505
Mailing Address - Street 1:19801 GOVERNORS HWY STE 160
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4363
Mailing Address - Country:US
Mailing Address - Phone:708-957-0505
Mailing Address - Fax:708-957-0506
Practice Address - Street 1:19801 GOVERNORS HWY STE 160
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4363
Practice Address - Country:US
Practice Address - Phone:708-957-0505
Practice Address - Fax:708-957-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILN/A261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical