Northwest Suburban Surgical Services

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

NORTHWEST SUBURBAN SURGICAL SERVICES

Practice address

39 S Virginia St
Suite 200
Crystal Lake, IL 60014-5826

Phone

(815) 477-8911

Fax

(815) 477-8911

NPI assigned

Jan 24, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Ronald Jay Leib

Title

Owner

Phone

(815) 477-8911

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740335165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 S VIRGINIA ST",
            "address_2": "SUITE 200",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600145826",
            "telephone_number": "815-477-8911",
            "fax_number": "815-477-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 S VIRGINIA ST",
            "address_2": "SUITE 200",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600145826",
            "telephone_number": "815-477-8911",
            "fax_number": "815-477-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SUBURBAN SURGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEIB",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-477-8911",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• 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.