MEDICARE: PREMIER ANESTHESIOLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1023009826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ANESTHESIOLOGY LLC

Provider Business Mailing Address
First Line	:	3333 N SEMINARY ST
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-1251
Country	:	US
Telephone Number	:	309-344-3161
Fax Number	:	309-344-9478

Provider Business Practice Location Address
First Line	:	3333 N SEMINARY ST
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-1251
Country	:	US
Telephone Number	:	309-344-3161
Fax Number	:	309-344-9478

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	PHILIP S DOH
Credential	:	MD
Telephone Number	:	309-344-3161

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	08/22/2020

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