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Organization

UROLOGIC SURGERY ASSOCIATES, S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ANNE THOMAS R.N. (OFFICE MANAGER)
(309) 661-9999
Entity
Organization

Contact information

Practice address
1414 WOODBINE RD, BLOOMINGTON, IL 61704-2817
(309) 661-9999
(309) 662-0748
Mailing address
1414 WOODBINE RD, BLOOMINGTON, IL 61704-2817
(309) 661-9999
(309) 662-0748

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
042007836
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5007705
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/22/2007
Last updated
05/16/2012
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