Provider Demographics
NPI:1922664622
Name:PREMIER CARDIAC SURGERY CENTER, PLLC
Entity type:Organization
Organization Name:PREMIER CARDIAC SURGERY CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:STELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-478-3600
Mailing Address - Street 1:11560 S. KEDZIE AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MERRIONETTE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60803
Mailing Address - Country:US
Mailing Address - Phone:708-972-7520
Mailing Address - Fax:708-972-7521
Practice Address - Street 1:11560 S. KEDZIE AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803
Practice Address - Country:US
Practice Address - Phone:708-972-7520
Practice Address - Fax:708-972-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical