Healthcare Provider Details

I. General information

NPI: 1316009194
Provider Name (Legal Business Name): ADVOCATE SOUTHWEST AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 S. LAGRANGE RD
TINLEY PARK IL
60487
US

IV. Provider business mailing address

18200 S. LAGRANGE RD
TINLEY PARK IL
60487
US

V. Phone/Fax

Practice location:
  • Phone: 708-570-2490
  • Fax: 708-570-2499
Mailing address:
  • Phone: 708-570-2490
  • Fax: 708-570-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7002652
License Number StateIL

VIII. Authorized Official

Name: MR. RONALD P LADNIAK
Title or Position: ADMINISTRATOR
Credential:
Phone: 630-852-9300