Sauk Valley Surgical, PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036082587 Issued in IL

Legal business name

SAUK VALLEY SURGICAL, PC

Practice address

102 S Hennepin Ave
Suite 120
Dixon, IL 61021-3083

Phone

(815) 288-1052

Fax

(815) 284-0584

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Jaquelyne K Naylor, LPN

Title

Office Manager

Phone

(815) 288-1052

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267660800000",
    "number": "1619192556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 514",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610210514",
            "telephone_number": "815-288-1052",
            "fax_number": "815-284-0584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE",
            "address_2": "SUITE 120",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "610213083",
            "telephone_number": "815-288-1052",
            "fax_number": "815-284-0584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAUK VALLEY SURGICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2010-03-04",
        "status": "A",
        "authorized_official_last_name": "NAYLOR",
        "authorized_official_first_name": "JAQUELYNE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "815-288-1052",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "036082587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036082587",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madeline Sanders
• Nate Sandrock
• Michael Joseph Sarno, PT
• Sauk Valley Open MRI, LLC
• Sauk Valley Orthodontics, PC
• Vijaya A Sayana, M.D.
• Karen Scanlan, DEVELOPMENTAL THERAP
• Brandon M. Schaffer, MHP
• Taylor Schauff
• Julie Kaye Schmelzle, RSA

• Surgery Physician in Dixon, IL
• Providers in Dixon, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2010; 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.