Healthcare Provider Details

I. General information

NPI: 1982781985
Provider Name (Legal Business Name): JOLIET SURGICAL FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ONEIDA ST STE 300
JOLIET IL
60435-6544
US

IV. Provider business mailing address

8255 LEMONT RD STE 200
DARIEN IL
60561-1800
US

V. Phone/Fax

Practice location:
  • Phone: 815-730-6800
  • Fax: 815-730-6868
Mailing address:
  • Phone: 630-598-2624
  • Fax: 630-598-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. SCOTT RICHARD ANDERSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 630-568-2624