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General NPI Number Information
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NPI Number | 1639333925
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Entity Type | Organization
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Legal Business Name | ROUNDTRIP ANESTHESIA, INC.
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 2150 W POTOMAC AVE #2
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City | CHICAGO
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State | IL
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Zip | 60622-3010
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Country | US
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Telephone | 312-401-3568
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Fax | 773-661-1194
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Provider Business Mailing Address
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Address Line | 2150 W POTOMAC AVE #2
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City | CHICAGO
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State | IL
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Zip | 60622-3010
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Country | US
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Telephone | 312-401-3568
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Fax | 773-661-1194
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Authorized Official
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Title or Position | NURSE ANESTHETIST
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Name | MR. GARY ALLEN KRAMER
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Credential | CRNA
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Telephone | 312-401-3568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 209.005990
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License Number State | IL
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