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General NPI Number Information
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NPI Number | 1689884603
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Entity Type | Organization
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Legal Business Name | LIFE SURGICAL SERVICES INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1820 RIDGE RD
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City | HOMEWOOD
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State | IL
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Zip | 60430-1760
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Country | US
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Telephone | 708-825-9329
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Fax | 708-658-1701
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Provider Business Mailing Address
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Address Line | PO BOX 44
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City | POSEN
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State | IL
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Zip | 60469-0044
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Country | US
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Telephone | 708-825-9329
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Fax | 708-658-1701
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RANDALL L JONES
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Credential | CSA
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Telephone | 708-799-1910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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