Basic Information
| Provider Information | |||||||||
| NPI: | 1093146771 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST COMMUNITY DAY SURGERY CENTER II LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3060 W SALT CREEK LN | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600051069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476184600 | ||||||||
| FaxNumber: | 8476184630 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 W KIRCHHOFF RD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600052371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476187009 | ||||||||
| FaxNumber: | 8476187069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2013 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | SCOGNA | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | O | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8476185000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 7001209 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 53466 | 01 | BLUE CROSS | OTHER |