MEDICARE: NORTHWEST COMMUNITY DAY SURGERY CENTER II 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	7001209	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53466	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1093146771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST COMMUNITY DAY SURGERY CENTER II LLC

Provider Business Mailing Address
First Line	:	3060 W SALT CREEK LN
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1069
Country	:	US
Telephone Number	:	847-618-4600
Fax Number	:	847-618-4630

Provider Business Practice Location Address
First Line	:	675 W KIRCHHOFF RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2371
Country	:	US
Telephone Number	:	847-618-7009
Fax Number	:	847-618-7069

Authorized Official
Title or Position	:	CEO
Name	:	STEPHEN O SCOGNA
Credential	:
Telephone Number	:	847-618-5000

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	03/21/2014

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