Provider Demographics
NPI: | 1205055639 |
---|---|
Name: | THE BAY SCOTT OPERATORY |
Entity type: | Organization |
Organization Name: | THE BAY SCOTT OPERATORY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | ROZNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 630-305-0010 |
Mailing Address - Street 1: | 1888 BAY SCOTT CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | NAPERVILLE |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60540-1106 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 630-305-0010 |
Mailing Address - Fax: | 630-305-0311 |
Practice Address - Street 1: | 1888 BAY SCOTT CIR |
Practice Address - Street 2: | |
Practice Address - City: | NAPERVILLE |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60540-1106 |
Practice Address - Country: | US |
Practice Address - Phone: | 630-305-0010 |
Practice Address - Fax: | 630-305-0311 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-24 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 261QA1903X | 261QA1903X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |