NPI:
1922664622
Provider Name:
PREMIER CARDIAC SURGERY CENTER, PLLC
Former Legal Business Name: PREMIER CARDIAC SURGERY CENTER, LLC
Classification:
Clinic/Center - 261QA1903X
Entity Type:
Organization
Specialization: Ambulatory Surgical
CLIA Number: 14D2163587
Address:
11560 S. KEDZIE AVENUE
SUITE 102
MERRIONETTE PARK, IL
ZIP 60803
Phone:
(708) 972-7520
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PREMIER CARDIAC SURGERY CENTER, PLLC is an ambulatory surgical clinic center in Merrionette Park, IL. PREMIER CARDIAC SURGERY CENTER, PLLC NPI is 1922664622. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Premier Cardiac Surgery Center, Llc.
The provider's business location address is:
11560 S. KEDZIE AVENUE
SUITE 102
MERRIONETTE PARK, IL
ZIP 60803
Phone: (708) 972-7520
Fax: (708) 972-7521
The provider's authorized official is Ronald E Stella .
The authorized official title is Board Chair and has the following contact phone number (708) 478-3600.
The CLIA number assigned to this NPI record is 14D2163587 - ambulatory surgery center with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 5/17/2019 and was last updated on 1/21/2022.