Provider Demographics
NPI:1972843175
Name:SURGICAL ASSISTANT INNOVATIONS, LLC
Entity Type:Organization
Organization Name:SURGICAL ASSISTANT INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:VLADIC
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:708-790-7333
Mailing Address - Street 1:1236 SHAGBARK CT
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-0806
Mailing Address - Country:US
Mailing Address - Phone:708-790-7333
Mailing Address - Fax:
Practice Address - Street 1:1236 SHAGBARK CT
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-0806
Practice Address - Country:US
Practice Address - Phone:708-790-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.258819163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty