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General NPI Number Information
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NPI Number | 1992709851
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Entity Type | Organization
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Legal Business Name | NOVAMED SURGERY CENTER OF CHICAGO-NORTHSHORE, LLC
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 3034 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-3729
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Country | US
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Telephone | 773-973-7432
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Fax | 773-973-1119
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Provider Business Mailing Address
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Address Line | 3034 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-3729
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Country | US
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Telephone | 773-973-7432
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Fax |
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Authorized Official
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Title or Position | OFFICER AND AUTHORIZED OFFICIAL
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Name | JENNIFER BOYD BALDOCK
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Credential |
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Telephone | 615-234-5900
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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 | 7002678
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License Number State | IL
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