Provider Demographics
NPI:1457385668
Name:RAVINE WAY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:RAVINE WAY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-998-5680
Mailing Address - Street 1:2350 RAVINE WAY
Mailing Address - Street 2:STE. 500
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7621
Mailing Address - Country:US
Mailing Address - Phone:847-998-5680
Mailing Address - Fax:847-998-6365
Practice Address - Street 1:2350 RAVINE WAY
Practice Address - Street 2:STE. 500
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7621
Practice Address - Country:US
Practice Address - Phone:847-998-5680
Practice Address - Fax:847-998-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical