MEDICARE: ADVANCED AMBULATORY SURGICAL CENTER, INC

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	1740688	IL

General Provider Information

NPI Number	:	1548390081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED AMBULATORY SURGICAL CENTER, INC

Provider Business Mailing Address
First Line	:	2333 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-2718
Country	:	US
Telephone Number	:	773-637-1700
Fax Number	:	773-637-2881

Provider Business Practice Location Address
First Line	:	2333 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-2718
Country	:	US
Telephone Number	:	773-637-1700
Fax Number	:	773-637-2881

Authorized Official
Title or Position	:	COO
Name	:	MS. JOANNA BRZOSTOWSKA
Credential	:
Telephone Number	:	773-637-1700

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	10/28/2014

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