MEDICARE: AMBULATORY SURGERY CENTERS OF CHICAGO

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	036093902	IL

General Provider Information

NPI Number	:	1437347796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBULATORY SURGERY CENTERS OF CHICAGO

Provider Business Mailing Address
First Line	:	PO BOX 14704
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-0704
Country	:	US
Telephone Number	:	773-327-2400
Fax Number	:	773-327-4759

Provider Business Practice Location Address
First Line	:	2449 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2414
Country	:	US
Telephone Number	:	773-327-2400
Fax Number	:	773-327-4759

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. LIZBETH CANALES
Credential	:
Telephone Number	:	773-327-2400

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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