Organization
ILLINOIS SPORTS MEDICINE & ORTHOPEDIC SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY J PARRISH (ADMINISTRATOR)
(847) 213-5455
Entity
Organization
Contact information
Practice address
9000 WAUKEGAN RD, SUITE 120, MORTON GROVE, IL 60053-2127
(847) 213-5444
(847) 213-5499
Mailing address
9000 WAUKEGAN RD, SUITE 120, MORTON GROVE, IL 60053-2127
(847) 213-5444
(847) 213-5499
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7003118
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7003118
LICENSE
IL
Enumeration date
01/12/2007
Last updated
08/22/2020
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