Basic Information
| Provider Information | |||||||||
| NPI: | 1437601200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROPARTNERS SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2245 ENTERPRISE DR | ||||||||
| Address2: | STE 4506 | ||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601545813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084920502 | ||||||||
| FaxNumber: | 7084920565 | ||||||||
| Practice Location | |||||||||
| Address1: | 2750 S RIVER RD | ||||||||
| Address2: | |||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600184103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084920502 | ||||||||
| FaxNumber: | 7084920565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2016 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7084505055 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UROPARTNERS INVESTMENTS, LLC | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.