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General NPI Number Information
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NPI Number | 1518967082
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Entity Type | Organization
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Legal Business Name | NOVAMED SURGERY CENTER OF OAK LAWN, LLC
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 6311 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2201
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Country | US
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Telephone | 708-499-3355
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Fax | 708-425-5654
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Provider Business Mailing Address
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Address Line | 6311 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2201
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Country | US
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Telephone | 708-499-3355
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Fax | 708-425-5654
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Authorized Official
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Title or Position | CHIEF REVENUE CYCLE OFFICER
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Name | CANDICE B DAVIS
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Credential |
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Telephone | 916-990-7590
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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 | 7002843
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License Number State | IL
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