Provider Demographics
NPI:1982781985
Name:JOLIET SURGICAL FACILITY
Entity Type:Organization
Organization Name:JOLIET SURGICAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-568-2624
Mailing Address - Street 1:8255 LEMONT RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-1800
Mailing Address - Country:US
Mailing Address - Phone:630-598-2624
Mailing Address - Fax:630-598-2674
Practice Address - Street 1:2121 ONEIDA ST
Practice Address - Street 2:STE 300
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6544
Practice Address - Country:US
Practice Address - Phone:815-730-6800
Practice Address - Fax:815-730-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty