Healthcare Provider Details

I. General information

NPI: 1851407795
Provider Name (Legal Business Name): NORTHERN ILLINOIS SURGERY CENTER LIMITED PATRNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E DIEHL RD
NAPERVILLE IL
60563-1353
US

IV. Provider business mailing address

75 REMITTANCE DR SUITE 3278
CHICAGO IL
60675-1001
US

V. Phone/Fax

Practice location:
  • Phone: 630-505-7733
  • Fax: 630-799-0223
Mailing address:
  • Phone: 630-505-7733
  • Fax: 630-799-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7001860
License Number StateIL

VIII. Authorized Official

Name: ANTHONY J FATO
Title or Position: BUSINESS ADMINISTRATOR
Credential: MBA, CASC
Phone: 630-505-3383