Organization
CHAMPAIGN SURGICENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LEONARD (CEO)
(217) 383-3220
Entity
Organization
Contact information
Practice address
3103 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 902-2300
(217) 902-7735
Mailing address
611 W PARK ST, URBANA, IL 61801-2500
(217) 326-2955
(217) 326-2996
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
007002959
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025710
HEALTH ALLIANCE PROV ID
—
Enumeration date
12/08/2006
Last updated
02/06/2019
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