Healthcare Provider Details

I. General information

NPI: 1619112380
Provider Name (Legal Business Name): TRICOUNTY ANESTHESIA ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N HAMMES AVE
JOLIET IL
60435-8114
US

IV. Provider business mailing address

955 W. DOWNER PLACE MECS BILLING SERVICES
AURORA IL
60506
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-0095
  • Fax:
Mailing address:
  • Phone: 630-897-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number060-004994
License Number StateIL

VIII. Authorized Official

Name: JANE A. KRAY
Title or Position: PARTNER
Credential: CRNA
Phone: 630-690-7582