MEDICARE: TOWN SQUARE ANESTHESIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1669471017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN SQUARE ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 75098
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60675-5098
Country	:	US
Telephone Number	:	800-444-6110
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 DOTY RD
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-7509
Country	:	US
Telephone Number	:	815-338-2500
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	WILLIAM B WEEMS
Credential	:	M.D.
Telephone Number	:	815-338-2500

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	01/19/2022

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