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General NPI Number Information
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NPI Number | 1851317614
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Entity Type | Organization
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Legal Business Name | KENDALL POINTE SURGERY CENTER LLC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 100 W FIFTH STREET
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City | OSWEGO
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State | IL
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Zip | 60543
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Country | US
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Telephone | 630-449-0085
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Fax | 630-449-0090
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Provider Business Mailing Address
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Address Line | 100 W FIFTH STREET
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City | OSWEGO
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State | IL
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Zip | 60543
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Country | US
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Telephone | 630-449-0085
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Fax | 630-449-0090
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Authorized Official
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Title or Position | BOARD CHAIR
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Name | DR. SCOTT SPORER
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Credential |
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Telephone | 630-449-0085
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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 | 7002538
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License Number State | IL
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