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General NPI Number Information
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NPI Number | 1538909734
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR INSTITUTE AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 10 MARTIN AVE
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City | NAPERVILLE
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State | IL
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Zip | 60540-6535
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Country | US
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Telephone | 630-600-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 5396 LA-311
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City | HOUMA
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State | LA
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Zip | 70360
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Country | US
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Telephone |
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Fax |
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Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JACOB CORBELL
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Credential |
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Telephone | 630-600-0748
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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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