Illini Surgical Associates, Inc

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

ILLINI SURGICAL ASSOCIATES, INC

Practice address

6809 Armstrong CT
Woodridge, IL 60517-1526

Phone

(630) 795-1855

Fax

(630) 795-1844

NPI assigned

Oct 19, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Keith Allen Penrod, RSA

Title

President

Phone

(630) 795-1855

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1437231446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5306",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605170306",
            "telephone_number": "630-795-1855",
            "fax_number": "630-795-1844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6809 ARMSTRONG CT",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171526",
            "telephone_number": "630-795-1855",
            "fax_number": "630-795-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINI SURGICAL ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "PENROD",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-795-1855",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RSA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Hyde
• Amy Beth Iacch, RN
• Julianne Marie Iandoli, PA-C
• Mark Ron Ibe Sr., MSN, APRN, FNP-C
• Amanda Rose Ico, OD
• Illinois Bone and Joint Institute LLC
• Illinois Bone and Joint Institute, LLC
• Immediate Pain Care of Woodridge LLC
• Sylvia Irizarry, MD
• Brent A. Ito, DMD, MS

• Surgical Physician Assistant in Woodridge, IL
• Providers in Woodridge, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; 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.