Provider Demographics
NPI:1063605178
Name:ON-CALL SURGICAL SERVICES,LLC
Entity type:Organization
Organization Name:ON-CALL SURGICAL SERVICES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNELL
Authorized Official - Middle Name:LAVETT
Authorized Official - Last Name:SHOWELL
Authorized Official - Suffix:I
Authorized Official - Credentials:OPA-C/RSA-C
Authorized Official - Phone:847-283-0720
Mailing Address - Street 1:655 ROCKLAND RD
Mailing Address - Street 2:STE# 205
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1782
Mailing Address - Country:US
Mailing Address - Phone:847-283-0720
Mailing Address - Fax:847-283-0723
Practice Address - Street 1:655 ROCKLAND RD
Practice Address - Street 2:STE# 205
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1782
Practice Address - Country:US
Practice Address - Phone:847-283-0720
Practice Address - Fax:847-283-0723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHOWELL SURGICAL SERVICES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty