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
Update your record
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