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General NPI Number Information
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NPI Number | 1689821449
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Entity Type | Organization
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Legal Business Name | RELIABLE ANESTHESIA SERVICES, LLC
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Dates
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Enumeration Date | 08/24/2008
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 10323 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60655-1610
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Country | US
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Telephone | 773-779-8499
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Fax | 773-429-9972
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Provider Business Mailing Address
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Address Line | 10323 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60655-1610
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Country | US
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Telephone | 773-779-8499
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Fax | 773-429-9972
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME J HANNIGAN
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Credential | MD
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Telephone | 773-779-8499
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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 | 036088163
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License Number State | IL
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