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General NPI Number Information
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NPI Number | 1417028879
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALTY CENTER, LTD.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 6043 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5116
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Country | US
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Telephone | 773-745-5400
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Fax | 773-745-1998
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Provider Business Mailing Address
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Address Line | 6043 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5116
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Country | US
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Telephone | 773-745-5400
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Fax | 773-745-1998
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEFFREY J. BETMAN
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Credential | D.P.M.
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Telephone | 773-745-1919
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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 |
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License Number State |
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