1427080480 NPI number — TWIN CITY ANESTHESIA

Table of content: (NPI 1427080480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427080480 NPI number — TWIN CITY ANESTHESIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN CITY ANESTHESIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANESTHESIA ASSOCIATES OF MONROE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427080480
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 SHERWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE BLUFF
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60044-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-323-8887
Provider Business Mailing Address Fax Number:
847-615-2858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 MCMILLAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71291-5327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-8887
Provider Business Practice Location Address Fax Number:
847-615-2858
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYS
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
847-615-2200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1026778 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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