| Organization Name: | DEERPATH ORTHOPEDIC SURGICAL CENTER, LLC |
| NPI Number: | 1215040464 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIC JOHN ANDERSON (ADMINISTRATOR) |
| Mailing Address: | 1051 W Us Route 6 Morris |
| State: | IL US |
| Postal Code: | 604503349 |
| Phone Number: | 8153185666 |
| Fax Number: | 8153185676 |
| NPI Enumeration Date: | 08/15/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 7002785 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |