Healthcare Provider Details

I. General information

NPI: 1134086069
Provider Name (Legal Business Name): CHAMPAIGN SURGICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S MATTIS AVE
CHAMPAIGN IL
61821-5469
US

IV. Provider business mailing address

3103 FIELDS SOUTH DR
CHAMPAIGN IL
61822-3743
US

V. Phone/Fax

Practice location:
  • Phone: 217-326-9700
  • Fax: 217-326-9710
Mailing address:
  • Phone: 217-326-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS P HESCH
Title or Position: CFO
Credential:
Phone: 217-326-8231