Healthcare Provider Details

I. General information

NPI: 1861470486
Provider Name (Legal Business Name): ORLAND PARK SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 WEST 167 STREET
ORLAND PARK IL
60467-5561
US

IV. Provider business mailing address

9550 WEST 167 STREET
ORLAND PARK IL
60467-5561
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-7437
  • Fax:
Mailing address:
  • Phone: 708-478-7437
  • Fax: 708-679-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7002553
License Number StateIL

VIII. Authorized Official

Name: ERIKA HORSTMANN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 708-478-7437