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General NPI Number Information
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NPI Number | 1134343866
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Entity Type | Organization
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Legal Business Name | CENTER FOR FACIAL PLASTIC SURGERY, LTD
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 515 WEST OLD NORTHWEST HIGHWAY
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City | BARRINGTON
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State | IL
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Zip | 60010-6828
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Country | US
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Telephone | 847-304-1000
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Fax | 847-304-1182
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Provider Business Mailing Address
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Address Line | 515 W OLD NORTHWEST HWY
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City | BARRINGTON
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State | IL
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Zip | 60010-6828
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Country | US
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Telephone | 847-304-1000
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Fax | 847-304-1182
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY S. CHURCHILL
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Credential | M.D.
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Telephone | 847-304-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | NOT NEEDED
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License Number State | IL
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