Healthcare Provider Details

I. General information

NPI: 1952560013
Provider Name (Legal Business Name): ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E LAKE SHORE DR SUITE 2500
DECATUR IL
62521-3810
US

IV. Provider business mailing address

1800 E LAKE SHORE DR SUITE 2500
DECATUR IL
62521-3810
US

V. Phone/Fax

Practice location:
  • Phone: 217-464-5839
  • Fax: 217-464-1693
Mailing address:
  • Phone: 217-464-5839
  • Fax: 217-464-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANE L FANCHER
Title or Position: PRESIDENT
Credential: MD
Phone: 217-464-5839