# AMBULATORY SURGICAL CARE FACILITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497055032
- **Authorized official:** DR. DERRICK D WALLERY D.C. (CEO / PRESIDENT)
- **Authorized official phone:** (773) 283-3131

## Contact information

- **Practice address:** 1281 N FARNSWORTH AVE, AURORA, IL 60505-2445
- **Practice address phone:** (773) 283-3131
- **Mailing address:** 4176 W MONTROSE AVE, CHICAGO, IL 60641-2161
- **Mailing address phone:** (773) 283-3131
- **Mailing address fax:** (773) 283-0793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/29/2010
- **Last updated:** 10/29/2010