Provider Demographics
NPI:1922169291
Name:ADVANCED SURGICAL CARE OF NORTHERN ILLINOIS, LTD
Entity Type:Organization
Organization Name:ADVANCED SURGICAL CARE OF NORTHERN ILLINOIS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANIE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-381-8161
Mailing Address - Street 1:802 FOX GLN
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1860
Mailing Address - Country:US
Mailing Address - Phone:847-381-8161
Mailing Address - Fax:847-381-8167
Practice Address - Street 1:802 FOX GLN
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1860
Practice Address - Country:US
Practice Address - Phone:847-381-8161
Practice Address - Fax:847-381-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04929950OtherBC BS PROVIDER NO
IL=========6001001Medicaid
IL640090Medicare ID - Type UnspecifiedMEDICARE GROUP