Healthcare Provider Details

I. General information

NPI: 1518967082
Provider Name (Legal Business Name): NOVAMED SURGERY CENTER OF OAK LAWN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 W 95TH ST
OAK LAWN IL
60453-2201
US

IV. Provider business mailing address

6311 W 95TH ST
OAK LAWN IL
60453-2201
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-3355
  • Fax: 708-425-5654
Mailing address:
  • Phone: 708-499-3355
  • Fax: 708-425-5654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7002843
License Number StateIL

VIII. Authorized Official

Name: CANDICE B DAVIS
Title or Position: CHIEF REVENUE CYCLE OFFICER
Credential:
Phone: 916-990-7590