Basic Information
| Provider Information | |||||||||
| NPI: | 1619404878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADDISON SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11221 ROE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133870510 | ||||||||
| FaxNumber: | 9136852208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1580 W LAKE ST | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601011171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302857000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2017 | ||||||||
| LastUpdateDate: | 05/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | TASSET | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | BOARD MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 9133870510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.