Healthcare Provider Details

I. General information

NPI: 1568548592
Provider Name (Legal Business Name): TRI COUNTY ANESTHESIA S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 TREMONT ST
HOPEDALE IL
61747-0267
US

IV. Provider business mailing address

PO BOX 9030
WHEELING IL
60090-9030
US

V. Phone/Fax

Practice location:
  • Phone: 309-449-3321
  • Fax:
Mailing address:
  • Phone: 847-495-1617
  • Fax: 847-537-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE J ROSSI JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 309-449-3321