IRELAND GROVE CENTER FOR SURGERY LLC. NPI 1750567442

NPI Information

IRELAND GROVE CENTER FOR SURGERY LLC. is an ambulatory surgical clinic center in Bloomington, IL. IRELAND GROVE CENTER FOR SURGERY LLC. NPI is 1750567442. The provider is registered as an organization entity type.

The provider's business location address is:

3801 IRELAND GROVE ROAD
BLOOMINGTON, IL
ZIP 61704
Phone: (309) 664-0101
Fax: (309) 664-1010

The provider's authorized official is Scott R. Wilson .
The authorized official title is Administrator and has the following contact phone number (309) 664-0101.

The CLIA number assigned to this NPI record is 14D1078896 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/14/2008 and was last updated on 6/23/2009.

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:

Other Identifiers

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