Provider Demographics
NPI:1205234143
Name:ORTHOTEC SURGERY CENTER, INC
Entity type:Organization
Organization Name:ORTHOTEC SURGERY CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIR / GOVERNING BODY
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-860-3112
Mailing Address - Street 1:340 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:331-209-9903
Mailing Address - Fax:331-209-9927
Practice Address - Street 1:340 W BUTTERFIELD RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5047
Practice Address - Country:US
Practice Address - Phone:331-209-9903
Practice Address - Fax:331-209-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7003192261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14C0001151Medicare Oscar/Certification
ILF100218233Medicare PIN