MEDICARE: ASCENSION SAINT JOSEPH MSK JV, 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

General Provider Information

NPI Number	:	1568158020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION SAINT JOSEPH MSK JV, LLC

Provider Business Mailing Address
First Line	:	331 W SURF ST STE 5800
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-0084
Country	:	US
Telephone Number	:	312-896-7700
Fax Number	:	312-896-7701

Provider Business Practice Location Address
First Line	:	331 W SURF ST STE 5800
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-7227
Country	:	US
Telephone Number	:	615-656-8129
Fax Number	:

Authorized Official
Title or Position	:	VPO
Name	:	DOUG LASHELY
Credential	:
Telephone Number	:	580-512-3684

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	05/06/2026

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