MEDICARE: CATARACT SPECIALTY SURGICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1396171773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATARACT SPECIALTY SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	2218 RELIABLE PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0022
Country	:	US
Telephone Number	:	847-296-5700
Fax Number	:	847-227-2750

Provider Business Practice Location Address
First Line	:	28747 WOODWARD AVE
Second Line	:	LOWER LEVEL
City	:	BERKLEY
State	:	MI
Zip	:	48072-0929
Country	:	US
Telephone Number	:	248-584-4602
Fax Number	:	248-584-4630

Authorized Official
Title or Position	:	EVP AND CFO
Name	:	MR. SCOTT T. MACOMBER
Credential	:
Telephone Number	:	312-664-4100

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	02/27/2014

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