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NPI Code Detail

MEDICARE: ANESTHESIA ASSOCIATES OF STREATOR SC

MEDICARE: ANESTHESIA ASSOCIATES OF STREATOR SC
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
1367500000XCertified Registered Nurse Anesthetist
2207L00000XAnesthesiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105032038OTHERILBCBS

General Provider Information

NPI Number : 1437162989
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANESTHESIA ASSOCIATES OF STREATOR SC
Provider Business Mailing Address
First Line : PO BOX 570
Second Line :
City : LAKE FOREST
State : IL
Zip : 60045-0570
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 SPRING ST
Second Line :
City : STREATOR
State : IL
Zip : 61364-3332
Country : US
Telephone Number : 815-673-2311
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CALVIN SLOT
Credential :
Telephone Number : 815-673-2311
Provider Enumeration Date : 08/15/2006
Last Update Date : 10/29/2007

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Directions to “ANESTHESIA ASSOCIATES OF STREATOR SC ” Practice Location

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