Basic Information
| Provider Information | |||||||||
| NPI: | 1194782342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST COMMUNITY DAY SURGERY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3060 W SALT CREEK LN | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600055026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476184604 | ||||||||
| 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: | 04/28/2006 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZENN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8476185017 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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 | 544 | 01 | IL | BLUE CROSS | OTHER | 0001671515 | 01 | IL | BLUE SHIELD | OTHER | 6251175 | 01 | IL | AETNA | OTHER |