Northeast Dupage Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7002496 Issued in IL

Legal business name

NORTHEAST DUPAGE SURGERY CENTER, LLC

Practice address

1580 W Lake St
Addison, IL 60101-1171

Phone

(630) 285-7000

Fax

(630) 799-0223

NPI assigned

Oct 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anthony J Fato, MBA, CASC

Title

Business Administrator

Phone

(630) 505-3383

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Suburban Surgery Center of DuPage Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073609368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 REMITTANCE DR",
            "address_2": "SUITE 3279",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606751001",
            "telephone_number": "630-285-7000",
            "fax_number": "630-799-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 W LAKE ST",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601011171",
            "telephone_number": "630-285-7000",
            "fax_number": "630-799-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DUPAGE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FATO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "630-505-3383",
        "authorized_official_credential": "MBA, CASC"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7002496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "7002496",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suburban Surgery Center of DuPage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nilan Medical LLC
• Mary Susan Nogar, P.T.A.
• North Ave Immediate Care
• Northeast Dupage Family and Youth Services
• Northeast Dupage Family and Youth Services
• Nos Healthcare Inc.
• Riyad Y Nouna, DDS
• Ausencio Nunez, M.D
• Colleen Ann O'Brien, OTR
• Joshua Benjamin O'Leary

• All providers in Addison, IL
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.