Healthcare Provider Details

I. General information

NPI: 1437162989
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF STREATOR SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SPRING ST
STREATOR IL
61364-3332
US

IV. Provider business mailing address

PO BOX 570
LAKE FOREST IL
60045-0570
US

V. Phone/Fax

Practice location:
  • Phone: 815-673-2311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CALVIN SLOT
Title or Position: PRESIDENT
Credential:
Phone: 815-673-2311