Organization
MAQBOOL AHMAD
Active
Other names
Marion Eye Surgery Center, L.L.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAQBOOL AHMAD M.D. (OWNER)
(618) 993-5686
Entity
Organization
Contact information
Practice address
2900 BROADWAY ST, SUITE B, MOUNT VERNON, IL 62864-2341
(618) 993-5686
(618) 997-6250
Mailing address
1200 W DEYOUNG ST, P.O. BOX 1178, MARION, IL 62959-4437
(618) 993-5686
(618) 997-6250
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
036051996
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51524
BCBS OF ILLINOIS
IL
01
—
A03147
HEALTHLINK
IL
01
—
P00802628
MEDICARE RAILROAD
IL
Enumeration date
01/02/2009
Last updated
04/29/2010
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