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General NPI Number Information
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NPI Number | 1720085384
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Entity Type | Organization
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Legal Business Name | ELMHURST OUTPATIENT SURGERY CENTER LLC
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 1200 S YORK RD STE 1400
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City | ELMHURST
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State | IL
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Zip | 60126-5633
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Country | US
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Telephone | 630-758-8800
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Fax | 630-758-8805
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Provider Business Mailing Address
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Address Line | 1200 SOUTH YORK RD STE 1400
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City | ELMHURST
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State | IL
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Zip | 60126-5633
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Country | US
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Telephone | 630-758-8800
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Fax | 630-758-8805
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TINA MADONIA MENTZ
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Credential |
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Telephone | 630-758-8801
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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 | 7002330
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License Number State | IL
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