Provider Demographics
NPI:1851407795
Name:NORTHERN ILLINOIS SURGERY CENTER LIMITED PATRNERSHIP
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS SURGERY CENTER LIMITED PATRNERSHIP
Other - Org Name:THE CENTER FOR SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FATO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CASC
Authorized Official - Phone:630-505-3383
Mailing Address - Street 1:75 REMITTANCE DR
Mailing Address - Street 2:SUITE 3278
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1001
Mailing Address - Country:US
Mailing Address - Phone:630-505-7733
Mailing Address - Fax:630-799-0223
Practice Address - Street 1:475 E DIEHL RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1353
Practice Address - Country:US
Practice Address - Phone:630-505-7733
Practice Address - Fax:630-799-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7001860261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid