Healthcare Provider Details

I. General information

NPI: 1376629550
Provider Name (Legal Business Name): PHYSICIAN ANESTHESIA ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD
ELK GROVE VILLAGE IL
60007-3311
US

IV. Provider business mailing address

DEPARTMENT 4330
CAROL STREAM IL
60122-4330
US

V. Phone/Fax

Practice location:
  • Phone: 847-615-2200
  • Fax: 847-615-2858
Mailing address:
  • Phone: 847-615-2200
  • Fax: 847-615-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL TERNA
Title or Position: PRESIDENT
Credential: MD
Phone: 847-437-5500