Provider Demographics
NPI:1942335971
Name:PALOS SURGICENTER, LLC
Entity Type:Organization
Organization Name:PALOS SURGICENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-361-7800
Mailing Address - Street 1:7340 W COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1159
Mailing Address - Country:US
Mailing Address - Phone:708-361-3233
Mailing Address - Fax:708-361-4876
Practice Address - Street 1:7340 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1159
Practice Address - Country:US
Practice Address - Phone:708-361-3233
Practice Address - Fax:708-361-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50032Medicare UPIN
IL902450Medicare ID - Type Unspecified