# CPC SURGICAL SUITE LLC

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

## Provider details

- **NPI number:** 1538719778
- **Authorized official:** DR. JAMES M KELLY MD (DOCTOR)
- **Authorized official phone:** (815) 929-1520

## Contact information

- **Practice address:** 555 W COURT ST STE 100, KANKAKEE, IL 60901-3673
- **Practice address phone:** (815) 929-1520
- **Practice address fax:** (815) 614-3029
- **Mailing address:** 555 W COURT ST STE 100, KANKAKEE, IL 60901-3673
- **Mailing address phone:** (815) 929-1520
- **Mailing address fax:** (815) 614-3029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/19/2019
- **Last updated:** 03/16/2020