MEDICARE: NORTHWEST COMMUNITY DAY SURGERY CENTER INC

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	544	OTHER	IL	BLUE CROSS
2	0001671515	OTHER	IL	BLUE SHIELD
3	6251175	OTHER	IL	AETNA

General Provider Information

NPI Number	:	1194782342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST COMMUNITY DAY SURGERY CENTER INC

Provider Business Mailing Address
First Line	:	3060 W SALT CREEK LN
Second Line	:	SUITE 110
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-5026
Country	:	US
Telephone Number	:	847-618-4604
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	:	EXECUTIVE VICE PRESIDENT
Name	:	MR. MICHAEL B ZENN
Credential	:
Telephone Number	:	847-618-5017

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	06/11/2008

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