Healthcare Provider Details

I. General information

NPI: 1831257682
Provider Name (Legal Business Name): AMSOL ANESTHETISTS OF ILLINOIS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAPLE ST
EFFINGHAM IL
62401-2006
US

IV. Provider business mailing address

PO BOX 5471
HIGH POINT NC
27262-5471
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-1586
  • Fax:
Mailing address:
  • Phone: 217-347-1586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES W COTTRELL
Title or Position: PRESIDENT
Credential: MD
Phone: 217-347-1586