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General NPI Number Information
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NPI Number | 1063955078
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Entity Type | Organization
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Legal Business Name | LURIE CHILDRENS PEDIATRIC ANESTHESIA ASSOCIATES
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-6415
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Fax | 312-227-9409
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Provider Business Mailing Address
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Address Line | 225 E CHICAGO AVE BOX 118
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-6415
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Fax | 312-227-9409
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Authorized Official
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Title or Position | DIR OF CREDENTIALING & ENROLLMENT
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Name | MS. CHERYL WITHERS
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Credential | CPCS
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Telephone | 312-227-6415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number |
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License Number State |
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