Provider Demographics
NPI:1538719778
Name:CPC SURGICAL SUITE LLC
Entity type:Organization
Organization Name:CPC SURGICAL SUITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-929-1520
Mailing Address - Street 1:555 W COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3673
Mailing Address - Country:US
Mailing Address - Phone:815-929-1520
Mailing Address - Fax:815-614-3029
Practice Address - Street 1:555 W COURT ST STE 100
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3673
Practice Address - Country:US
Practice Address - Phone:815-929-1520
Practice Address - Fax:815-614-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty