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General NPI Number Information
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NPI Number | 1376576025
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF JOLIET, LLC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 301 MADISON ST STE 100
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City | JOLIET
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State | IL
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Zip | 60435-6557
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Country | US
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Telephone | 815-744-1119
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Fax | 815-744-1151
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Provider Business Mailing Address
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Address Line | 301 MADISON ST STE 100
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City | JOLIET
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State | IL
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Zip | 60435-6557
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Country | US
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Telephone | 815-744-1119
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Fax | 815-744-1151
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MARGE SCHILLACI
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Credential | MS, RN
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Telephone | 815-744-1119
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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 | 00939803
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License Number State | IL
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