MEDICARE: BELMONT/HARLEM 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

General Provider Information

NPI Number	:	1629256961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELMONT/HARLEM SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	3101 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4532
Country	:	US
Telephone Number	:	773-889-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4532
Country	:	US
Telephone Number	:	773-889-2000
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	FAITH MCHALE
Credential	:
Telephone Number	:	773-889-2000

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	12/18/2017

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