Healthcare Provider Details

I. General information

NPI: 1578006219
Provider Name (Legal Business Name): LIBERTY ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 W WINCHESTER RD SUITE 146
LIBERTYVILLE IL
60048-5358
US

IV. Provider business mailing address

PO BOX 775202
CHICAGO IL
60677-5202
US

V. Phone/Fax

Practice location:
  • Phone: 847-247-0187
  • Fax:
Mailing address:
  • Phone: 908-653-9399
  • Fax: 908-653-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DREW BELL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 818-317-5599