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General NPI Number Information
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NPI Number | 1619112380
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Entity Type | Organization
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Legal Business Name | TRICOUNTY ANESTHESIA ASSOCIATES, LTD.
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 219 N HAMMES AVE
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City | JOLIET
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State | IL
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Zip | 60435-8114
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Country | US
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Telephone | 815-741-0095
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Fax |
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Provider Business Mailing Address
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Address Line | 955 W. DOWNER PLACE MECS BILLING SERVICES
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City | AURORA
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State | IL
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Zip | 60506
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Country | US
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Telephone | 630-897-6851
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | JANE A. KRAY
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Credential | CRNA
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Telephone | 630-690-7582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 060-004994
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License Number State | IL
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