Provider Demographics
NPI:1861684458
Name:HISPANIC AMERICAN ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:HISPANIC AMERICAN ENDOSCOPY CENTER, LLC
Other - Org Name:CHICAGO SURGERY CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-761-0100
Mailing Address - Street 1:3536 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2443
Mailing Address - Country:US
Mailing Address - Phone:312-761-0100
Mailing Address - Fax:773-697-8305
Practice Address - Street 1:3536 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2443
Practice Address - Country:US
Practice Address - Phone:773-772-1212
Practice Address - Fax:773-697-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7003126261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical