| Organization Name: | 1800 MCDONOUGH ROAD SURGERY CENTER LLC |
| NPI Number: | 1053597161 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIANOOSH JAFARI (OWNER) |
| Mailing Address: | 1800 Mcdonough Rd Suite 100 Hoffman Estates |
| State: | IL US |
| Postal Code: | 601924566 |
| Phone Number: | 8477427272 |
| Fax Number: | |
| NPI Enumeration Date: | 01/18/2008 |
| NPI Last Update Date: | 01/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 7003116 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |