MEDICARE: VERMILION COUNTY 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
1	261QA1903X	Ambulatory Surgical Clinic/Center	7002363	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	141084	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558467936	OTHER		NPI NUMBER

General Provider Information

NPI Number	:	1508113580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERMILION COUNTY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	26 W WEST NEWELL RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-7488
Country	:	US
Telephone Number	:	217-446-1400
Fax Number	:	217-446-5907

Provider Business Practice Location Address
First Line	:	26 W WEST NEWELL RD
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-7488
Country	:	US
Telephone Number	:	217-446-1400
Fax Number	:	217-446-5907

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL L BROWN
Credential	:
Telephone Number	:	217-443-5201

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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Directions to “VERMILION COUNTY SURGERY CENTER, LLC ” Practice Location

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