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General NPI Number Information
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NPI Number | 1992259337
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Entity Type | Organization
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Legal Business Name | ADVOCATE CONDELL AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/14/2016
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 825 S MILWAUKEE AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3218
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Country | US
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Telephone | 312-489-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 825 S MILWAUKEE AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | STEPHANIE PASENELLI
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Credential |
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Telephone | 224-504-2215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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