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Organization
EASTLAND MEDICAL PLAZA SURGICENTER, LLC
Active
Organization
EASTLAND MEDICAL PLAZA SURGICENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE ANN FRYE (BUSINESS OFFICE MANAGER)
(309) 663-1997
Entity
Organization
Contact information
Practice address
1505 EASTLAND DR, BLOOMINGTON, IL 61701-3534
(309) 663-1997
(309) 662-9527
Mailing address
1505 EASTLAND DR, BLOOMINGTON, IL 61701-3534
(309) 663-1997
(309) 662-9527
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002413
IL
Other
Enumeration date
12/16/2005
Last updated
01/06/2010
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