Provider Demographics
NPI:1851669725
Name:SURGICAL CARE ASSOCIATES LTD
Entity Type:Organization
Organization Name:SURGICAL CARE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESHMUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-331-1122
Mailing Address - Street 1:71 W 156TH ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4260
Mailing Address - Country:US
Mailing Address - Phone:708-331-1122
Mailing Address - Fax:
Practice Address - Street 1:6703 159TH ST STE 110
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1782
Practice Address - Country:US
Practice Address - Phone:708-331-1122
Practice Address - Fax:708-331-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090773208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty