Healthcare Provider Details

I. General information

NPI: 1285174557
Provider Name (Legal Business Name): PRIORITY ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S LINCOLN AVE
PARK RIDGE IL
60068-4506
US

IV. Provider business mailing address

PO BOX 4860
MURRELLS INLET SC
29576-2698
US

V. Phone/Fax

Practice location:
  • Phone: 847-208-0353
  • Fax:
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-491-4023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. BERTRAND D CHAUFF
Title or Position: OWNER
Credential: CRNA
Phone: 847-208-0353