Healthcare Provider Details

I. General information

NPI: 1548181720
Provider Name (Legal Business Name): PRIME HEALTHCARE ASC - JOLIET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MADISON ST STE 100
JOLIET IL
60435-6651
US

IV. Provider business mailing address

301 MADISON ST STE 100
JOLIET IL
60435-6651
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-1119
  • Fax:
Mailing address:
  • Phone: 815-744-1119
  • 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: CHRISTOPHER DOAN
Title or Position: MANAGING ASSOCIATE GENERAL COUNSEL
Credential:
Phone: 310-259-4706