MEDICARE: MEC ADVANCED SURGICAL INSTITUTE 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	261QS0132X	Ophthalmologic Surgery Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1801744719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEC ADVANCED SURGICAL INSTITUTE LLC

Provider Business Mailing Address
First Line	:	1202 W DEYOUNG ST
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959
Country	:	US
Telephone Number	:	618-967-1396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 W DEYOUNG ST
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959
Country	:	US
Telephone Number	:	618-967-1396
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JACKIE WIEDEMANN
Credential	:
Telephone Number	:	816-610-8511

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	05/28/2026

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