Healthcare Provider Details

I. General information

NPI: 1548538192
Provider Name (Legal Business Name): SURGICAL ASSISTING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2011
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16525 W 159TH ST #140
LOCKPORT IL
60441-7900
US

IV. Provider business mailing address

16525 W 159TH ST #140
LOCKPORT IL
60441-7900
US

V. Phone/Fax

Practice location:
  • Phone: 708-602-2183
  • Fax: 815-600-8637
Mailing address:
  • Phone: 708-602-2183
  • Fax: 815-600-8637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number238.000243
License Number StateIL

VIII. Authorized Official

Name: MR. NOEL C TEODORO
Title or Position: OWNER
Credential: RSA
Phone: 708-602-2183