ANTI AGING SURGICAL CENTER NPI 1245466192

NPI Information

NPI: 1245466192
Provider Name: ANTI AGING SURGICAL CENTER
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 14D2155699

Address:
3918 W 63RD ST
CHICAGO, IL
ZIP 60629
Phone: (773) 284-9660
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ANTI AGING SURGICAL CENTER is an ambulatory surgical clinic center in Chicago, IL. ANTI AGING SURGICAL CENTER NPI is 1245466192. The provider is registered as an organization entity type.

The provider's business location address is:

3918 W 63RD ST
CHICAGO, IL
ZIP 60629-604
Phone: (773) 284-9660

The provider's authorized official is Shanin Moshiri .
The authorized official title is Medical Director/own and has the following contact phone number (773) 284-9660.

The CLIA number assigned to this NPI record is 14D2155699 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/5/2009 and was last updated on 8/6/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	60011238	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	OTHER	ILLINOIS	PRIVATE INSURANCE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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