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General NPI Number Information
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NPI Number | 1063947422
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Entity Type | Organization
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Legal Business Name | SILVER CROSS AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1003 PAWLAK PARKWAY
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City | NEW LENOX
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State | IL
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Zip | 60451
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Country | US
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Telephone | 815-717-1740
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Fax | 815-320-3240
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Provider Business Mailing Address
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Address Line | 1003 PAWLAK PARKWAY
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City | NEW LENOX
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State | IL
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Zip | 60451
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Country | US
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Telephone | 815-717-1740
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Fax | 815-320-3240
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JONATHAN BAILEY
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Credential |
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Telephone | 203-609-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7003216
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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