Organization
WESTERN ILLINOIS SURGICAL ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN L CARD M.D. (OWNER)
(309) 833-3706
Entity
Organization
Contact information
Practice address
515 E GRANT ST STE 211, MACOMB, IL 61455-3378
(309) 833-3706
Mailing address
515 E GRANT ST STE 211, MACOMB, IL 61455-3378
(309) 833-3706
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
724860
REW GROUP PTAN
IL
01
—
K46143
PROVIDER NUMBER
IL
01
—
K46871
REW PTAN
—
Enumeration date
03/19/2007
Last updated
10/22/2008
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