Provider Demographics
NPI:1922141647
Name:RIVER NORTH SAME DAY SURGERY LLC
Entity Type:Organization
Organization Name:RIVER NORTH SAME DAY SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADHAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-573-2981
Mailing Address - Street 1:1 E ERIE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2740
Mailing Address - Country:US
Mailing Address - Phone:312-649-3939
Mailing Address - Fax:312-649-5747
Practice Address - Street 1:1 E ERIE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2740
Practice Address - Country:US
Practice Address - Phone:312-649-3939
Practice Address - Fax:312-649-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002090261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL518OtherBCBS
IL518OtherBCBS
IL212145Medicare ID - Type Unspecified
IL=========001Medicaid