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General NPI Number Information
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NPI Number | 1932145000
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS ANESTHESIA LTD
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 2030 SHERMAN DR
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City | PRINCETON
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State | IN
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Zip | 47670-1045
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Country | US
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Telephone | 812-385-5820
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Fax | 812-385-5826
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Provider Business Mailing Address
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Address Line | PO BOX 3276
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City | EVANSVILLE
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State | IN
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Zip | 47731-3276
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Country | US
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Telephone | 812-473-0181
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Fax | 812-473-5822
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS L GRIGGS
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Credential | CRNA
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Telephone | 812-473-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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