Healthcare Provider Details

I. General information

NPI: 1598521312
Provider Name (Legal Business Name): ALPHA SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 S HARLEM AVE STE 5
BERWYN IL
60402-2996
US

IV. Provider business mailing address

3253 S HARLEM AVE STE 5
BERWYN IL
60402-2996
US

V. Phone/Fax

Practice location:
  • Phone: 708-788-3880
  • Fax: 708-788-4757
Mailing address:
  • Phone: 630-854-0899
  • Fax: 708-788-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHISH SUD
Title or Position: OWNER
Credential: DC
Phone: 630-854-0899