Healthcare Provider Details

I. General information

NPI: 1215263066
Provider Name (Legal Business Name): AMBASSADOR HOSPITAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 DAKOTA ST SUITE A
CRYSTAL LAKE IL
60012-3744
US

IV. Provider business mailing address

650 DAKOTA ST SUITE A
CRYSTAL LAKE IL
60012-3744
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-6100
  • Fax: 815-356-1104
Mailing address:
  • Phone: 815-455-6100
  • Fax: 815-356-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS G SALVI
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 815-455-6000