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General NPI Number Information
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NPI Number | 1215040464
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Entity Type | Organization
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Legal Business Name | DEERPATH AMBULATORY SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 1051 W US ROUTE 6
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City | MORRIS
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State | IL
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Zip | 60450
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Country | US
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Telephone | 815-318-5666
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Fax | 815-318-5676
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Provider Business Mailing Address
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Address Line | 1051 W US ROUTE 6
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City | MORRIS
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State | IL
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Zip | 60450-3349
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Country | US
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Telephone | 815-318-5666
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Fax | 815-318-5676
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ASHLEY HILLIARD
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Credential |
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Telephone | 815-318-5626
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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 |
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License Number State |
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