Organization
NOVAMED SURGERY CENTER OF CHICAGO-NORTHSHORE, LLC
Active
Organization
NOVAMED SURGERY CENTER OF CHICAGO-NORTHSHORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
(615) 234-5900
Entity
Organization
Contact information
Practice address
3034 W PETERSON AVE, CHICAGO, IL 60659-3729
(773) 973-7432
(773) 973-4134
Mailing address
3034 W PETERSON AVE, CHICAGO, IL 60659-3729
(773) 973-7432
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA0181
RR MEDICARE
—
Enumeration date
06/14/2005
Last updated
07/21/2022
Update your record
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