MEDICARE: RIVER NORTH SAME DAY SURGERY 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	7002090	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	518	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1922141647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER NORTH SAME DAY SURGERY LLC

Provider Business Mailing Address
First Line	:	4698 DEPT
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-4698
Country	:	US
Telephone Number	:	312-921-2055
Fax Number	:	312-921-2056

Provider Business Practice Location Address
First Line	:	1 E ERIE ST
Second Line	:	SUITE 300
City	:	CHICAGO
State	:	IL
Zip	:	60611-2740
Country	:	US
Telephone Number	:	312-921-2055
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT HOSPITAL REVENUE CYC
Name	:	MICHAEL J MULLEN
Credential	:
Telephone Number	:	630-938-6076

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	06/18/2024

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Directions to “RIVER NORTH SAME DAY SURGERY LLC ” Practice Location

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