Healthcare Provider Details

I. General information

NPI: 1841471497
Provider Name (Legal Business Name): HUANG SURGICAL CLINIC LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2007
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2004
US

IV. Provider business mailing address

270 MAPLE SUMMIT RD
JERSEYVILLE IL
62052-2004
US

V. Phone/Fax

Practice location:
  • Phone: 618-498-5722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: SUSAN HUANG
Title or Position: OFFICE MANAGER
Credential:
Phone: 618-498-5722