Healthcare Provider Details

I. General information

NPI: 1194885137
Provider Name (Legal Business Name): UNITED SURGICAL ASSISTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 ALMAR PKWY SUITE 205
BOURBONNAIS IL
60914-2315
US

IV. Provider business mailing address

750 ALMAR PKWY SUITE 205
BOURBONNAIS IL
60914-2315
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-3955
  • Fax: 815-933-3944
Mailing address:
  • Phone: 815-933-3955
  • Fax: 815-933-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. PAULA JACOBI
Title or Position: BUSINESS MANAGER
Credential:
Phone: 815-933-3955