Healthcare Provider Details

I. General information

NPI: 1770752362
Provider Name (Legal Business Name): RLH ANESTHESIA SERVICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 SKIERS RUN
BENTON IL
62812
US

IV. Provider business mailing address

PO BOX 1431
BENTON IL
62812-5431
US

V. Phone/Fax

Practice location:
  • Phone: 618-439-2800
  • Fax: 618-439-2800
Mailing address:
  • Phone: 618-439-2800
  • Fax: 618-439-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT L HITT
Title or Position: OWNER
Credential: CRNA
Phone: 618-439-2800