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NPI Code Detail

MEDICARE: DREYER AMBULATORY SURGERY CENTER, LLC

MEDICARE: DREYER AMBULATORY SURGERY 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
1261QA1903XAmbulatory Surgical Clinic/Center7001779IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1590OTHERBLUE SHIELD

General Provider Information

NPI Number : 1396896684
Entity Type Code : Organization
Provider Name (Legal Business Name) : DREYER AMBULATORY SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 28602 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1286
Country : US
Telephone Number : 630-264-8400
Fax Number : 630-264-8402
Provider Business Practice Location Address
First Line : 1221 N HIGHLAND AVE
Second Line :
City : AURORA
State : IL
Zip : 60506-1404
Country : US
Telephone Number : 630-264-8400
Fax Number : 630-264-8402
Authorized Official
Title or Position : VP MANAGED HEALTH
Name : KARA RICHARDSON
Credential :
Telephone Number : 980-416-4068
Provider Enumeration Date : 01/15/2007
Last Update Date : 01/28/2026

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