Organization
TEAMVISION MSO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TILLIE ANDRADE (CREDENTIALING SPECIALIST)
(702) 449-9173
Entity
Organization
Contact information
Practice address
100 W CALENDAR AVE, LA GRANGE, IL 60525-2325
(708) 354-0500
Mailing address
6235 CERMAK RD, BERWYN, IL 60402-2317
(708) 354-0500
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
—
—
Other
Enumeration date
11/07/2024
Last updated
01/17/2025
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