=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740483130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGHLAND SURGERY CARE CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 09/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1177 N HIGHLAND AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-801-9009
-----------------------------------------------------
Fax | 630-966-1611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1177 N HIGHLAND AVE
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-801-9009
-----------------------------------------------------
Fax | 630-966-1611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT W BOER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-801-9009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------