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General NPI Number Information
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NPI Number | 1982781985
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Entity Type | Organization
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Legal Business Name | JOLIET SURGICAL FACILITY
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2121 ONEIDA ST STE 300
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City | JOLIET
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State | IL
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Zip | 60435-6544
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Country | US
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Telephone | 815-730-6800
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Fax | 815-730-6868
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Provider Business Mailing Address
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Address Line | 8255 LEMONT RD STE 200
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City | DARIEN
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State | IL
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Zip | 60561-1800
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Country | US
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Telephone | 630-598-2624
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Fax | 630-598-2674
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. SCOTT RICHARD ANDERSON
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Credential |
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Telephone | 630-568-2624
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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 |
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