MEDICARE: NORTHEAST DUPAGE SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	7002496	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7002496	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1073609368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST DUPAGE SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	75 REMITTANCE DR
Second Line	:	SUITE 3279
City	:	CHICAGO
State	:	IL
Zip	:	60675-1001
Country	:	US
Telephone Number	:	630-285-7000
Fax Number	:	630-799-0223

Provider Business Practice Location Address
First Line	:	1580 W LAKE ST
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-1171
Country	:	US
Telephone Number	:	630-285-7000
Fax Number	:	630-799-0223

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	ANTHONY J FATO
Credential	:	MBA, CASC
Telephone Number	:	630-505-3383

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1922248517 — AIDEN CENTER FOR DAY SURGERY LLC
Practice Location Address:

1580 W LAKE ST
ADDISON, IL
60101-1171

Practice Phone: 630-285-7000
Practice Fax:

1528997103 — BRITTANY JEANNE TAMASON LCSW
Practice Location Address:

777 W ARMY TRAIL BLVD
ADDISON, IL
60101-3163

Practice Phone: 630-693-7934
Practice Fax:

1033279203 — DR. KENNETH MASAYUKI HAMADA D.D.S.
Practice Location Address:

1201 W ARMY TRAIL BLVD
ADDISON, IL
60101-3152

Practice Phone: 630-543-8688
Practice Fax: 630-543-8692

1760926109 — MRS. NICOLE M ZARTH APN-CNP
Practice Location Address:

303 W LAKE ST
ADDISON, IL
60101-2586

Practice Phone: 630-527-3645
Practice Fax: 331-221-3983

1255269056 — STEPHANIE AVILA
Practice Location Address:

857 S WISCONSIN AVE
ADDISON, IL
60101-4841

Practice Phone: 630-891-1452
Practice Fax:

1992535322 — SARAH GISELLE MARTINEZ
Practice Location Address:

1111 W LAKE ST
ADDISON, IL
60101-1101

Practice Phone: 630-682-7400
Practice Fax:

Directions to “NORTHEAST DUPAGE SURGERY CENTER, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.