Organization
25 EAST SAME DAY SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENETHA D MORAN (AUTHORIZED OFFICIAL)
(972) 763-3893
Entity
Organization
Contact information
Practice address
25 E WASHINGTON ST, SUITE 300, CHICAGO, IL 60602-1708
(312) 726-3329
(312) 726-3823
Mailing address
25 E WASHINGTON ST, SUITE 300, CHICAGO, IL 60602-1733
(312) 726-3329
(312) 726-3823
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7001969
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1514
BCBS
IL
Enumeration date
02/14/2007
Last updated
09/18/2018
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