Organization
LGH-A/GOLF ASTC, LLC
Active
Other names
GOLF SURGICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE KIRKMAN (CEO)
(847) 321-6698
Entity
Organization
Contact information
Practice address
8901 GOLF RD, DES PLAINES, IL 60016
(847) 299-2273
(847) 299-7861
Mailing address
8901 GOLF RD, DES PLAINES, IL 60016-6850
(847) 299-2273
(847) 299-7861
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002231
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490001093
RAILROAD MEDICARE
IL
01
—
545
BLUE CROSS PROVIDER NUMBE
IL
Enumeration date
08/09/2005
Last updated
07/17/2018
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