Provider Demographics
NPI:1104633866
Name:SURGERY CENTER FOR HUMAN REPRODUCTION, LLC
Entity type:Organization
Organization Name:SURGERY CENTER FOR HUMAN REPRODUCTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZONERAICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-834-7227
Mailing Address - Street 1:680 N LAKE SHORE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4448
Mailing Address - Country:US
Mailing Address - Phone:312-288-6420
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4447
Practice Address - Country:US
Practice Address - Phone:312-288-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical