Healthcare Provider Details

I. General information

NPI: 1992875454
Provider Name (Legal Business Name): ELGIN GASTROENTEROLOGY ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 FLETCHER DR FL 2
ELGIN IL
60123-4747
US

IV. Provider business mailing address

745 FLETCHER DR STE 201
ELGIN IL
60123-4749
US

V. Phone/Fax

Practice location:
  • Phone: 847-888-1300
  • Fax: 847-888-1341
Mailing address:
  • Phone: 847-888-5712
  • Fax: 847-608-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1710262
License Number StateIL

VIII. Authorized Official

Name: CARRIE LYNN LAWLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-888-5711