Organization
ELMHURST OUTPATIENT SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA MADONIA MENTZ (EXECUTIVE DIRECTOR)
(630) 758-8801
Entity
Organization
Contact information
Practice address
1200 S YORK RD, STE 1400, ELMHURST, IL 60126-5633
(630) 758-8800
(630) 758-8805
Mailing address
1200 SOUTH YORK RD, STE 1400, ELMHURST, IL 60126-5633
(630) 758-8800
(630) 758-8805
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002330
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490004570
MEDICARE FOR RAILROAD EMPLOYEES
IL
Enumeration date
06/28/2005
Last updated
05/12/2008
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