1699724781 NPI number — STAT ANESTHESIA SPECIALISTS LTD

Table of content: (NPI 1699724781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699724781 NPI number — STAT ANESTHESIA SPECIALISTS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAT ANESTHESIA SPECIALISTS LTD
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:
Provider Other Organization Name Type Code:
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:
1699724781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/28/2013
NPI Reactivation Date:
10/23/2013

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18221 TORRENCE AVE
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60438-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-895-9450
Provider Business Mailing Address Fax Number:
708-895-9455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10220 WICKER AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SAINT JOHN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46373-9424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-515-6943
Provider Business Practice Location Address Fax Number:
708-895-9455
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLLACHEK
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-805-8900

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  64718096 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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