1740514140 NPI number — EMERGENCY SURGICAL SERVICES OF LAKE COUNTY LLC

Table of content: (NPI 1740514140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740514140 NPI number — EMERGENCY SURGICAL SERVICES OF LAKE COUNTY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY SURGICAL SERVICES OF LAKE COUNTY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740514140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1870 W WINCHESTER RD
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-5358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-513-5239
Provider Business Mailing Address Fax Number:
847-816-7497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1870 W WINCHESTER RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-5358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-513-5239
Provider Business Practice Location Address Fax Number:
847-816-7497
Provider Enumeration Date:
10/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
224-513-5239

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com