Organization
IRELAND GROVE CENTER FOR SURGERY LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD KOLB MD (PRESIDENT)
(309) 664-0101
Entity
Organization
Contact information
Practice address
3801 IRELAND GROVE ROAD, BLOOMINGTON, IL 61704
(309) 664-0101
(309) 664-1010
Mailing address
3801 IRELAND GROVE ROAD, BLOOMINGTON, IL 61704
(309) 664-0101
(309) 664-1010
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164419818
NPI
IL
01
—
1285633420
NPI
IL
01
—
1538168786
NPI
IL
01
—
1558347310
NPI
IL
01
—
1760543615
NPI
IL
01
—
1992813174
NPI
IL
01
—
IL1464
PTAN
IL
Enumeration date
01/14/2008
Last updated
03/27/2026
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