Organization
SAUK VALLEY SURGICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAQUELYNE K NAYLOR LPN (OFFICE MANAGER)
(815) 288-1052
Entity
Organization
Contact information
Practice address
102 S HENNEPIN AVE, SUITE 120, DIXON, IL 61021-3083
(815) 288-1052
(815) 284-0584
Mailing address
PO BOX 514, DIXON, IL 61021-0514
(815) 288-1052
(815) 284-0584
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036082587
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082587
—
IL
Enumeration date
04/16/2007
Last updated
03/04/2010
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