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General NPI Number Information
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NPI Number | 1487107108
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Entity Type | Organization
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Legal Business Name | JW ANESTHESIA SC
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 1811 SAINT JOHNS AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5607
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Country | US
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Telephone | 708-669-9313
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Fax | 708-377-9354
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Provider Business Mailing Address
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Address Line | 1811 SAINT JOHNS AVE
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5607
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Country | US
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Telephone | 708-669-9313
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Fax | 708-377-9354
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Authorized Official
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Title or Position | BILLING
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Name | JOHN GWIN
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Credential |
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Telephone | 708-669-9313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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