Provider Demographics
NPI:1194159467
Name:ELMWOOD PARK SURGERY CENTER ACQUISITION & DEVELOPMENT LLC
Entity type:Organization
Organization Name:ELMWOOD PARK SURGERY CENTER ACQUISITION & DEVELOPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OR COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:847-869-9700
Mailing Address - Street 1:1614 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4302
Mailing Address - Country:US
Mailing Address - Phone:847-869-9700
Mailing Address - Fax:847-869-7979
Practice Address - Street 1:1614 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4302
Practice Address - Country:US
Practice Address - Phone:847-869-9700
Practice Address - Fax:847-869-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical