Organization
NOVAMED SURGERY CENTER OF CHICAGO-NORTHSHORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
(615) 234-5900
Entity
Organization
Contact information
Practice address
3034 W PETERSON AVE, CHICAGO, IL 60659-3729
(773) 973-7432
(773) 973-1119
Mailing address
3034 W PETERSON AVE, CHICAGO, IL 60659-3729
(773) 973-7432
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002678
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
326488082001
—
IL
01
—
P00012000
RR MEDICARE
—
Enumeration date
06/09/2005
Last updated
05/11/2021
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