=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699918755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KHEM SURGICAL SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2009
-----------------------------------------------------
Last Update Date | 04/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 PICKFORD RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60538-2612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-896-4394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 PICKFORD RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60538-2612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-896-4394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGICAL TECHNOLOGIST
-----------------------------------------------------
Name | KHEM SINGH
-----------------------------------------------------
Credential | CFA
-----------------------------------------------------
Telephone | 630-896-4394
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZS0410X
-----------------------------------------------------
Taxonomy Name | Surgical Technologist
-----------------------------------------------------
License Number | 238.000129
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------