Provider Demographics
NPI:1871612333
Name:GRUNDY COUNTY SURGICAL FACILITY
Entity type:Organization
Organization Name:GRUNDY COUNTY SURGICAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-942-6511
Mailing Address - Street 1:425 E US ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-9042
Mailing Address - Country:US
Mailing Address - Phone:815-942-6511
Mailing Address - Fax:815-942-6582
Practice Address - Street 1:425 E US ROUTE 6
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-9042
Practice Address - Country:US
Practice Address - Phone:815-942-6511
Practice Address - Fax:815-942-6582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical