Provider Demographics
NPI:1720165723
Name:SUBURBAN SURGICAL FACILITY
Entity Type:Organization
Organization Name:SUBURBAN SURGICAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-810-0451
Mailing Address - Street 1:535 S WASHINGTON ST
Mailing Address - Street 2:STE 22
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6795
Mailing Address - Country:US
Mailing Address - Phone:630-810-0451
Mailing Address - Fax:877-446-3870
Practice Address - Street 1:18660 GRAPHIC DR
Practice Address - Street 2:STE 100
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6260
Practice Address - Country:US
Practice Address - Phone:630-810-0451
Practice Address - Fax:877-446-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical