Basic Information
| Provider Information | |||||||||
| NPI: | 1013475375 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIGILANCE ANESTHESIOLOGISTS & PAIN SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70 | ||||||||
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| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600450070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5363 COMMERCE BLVD | ||||||||
| Address2: | |||||||||
| City: | CROWN POINT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463075325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197560600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2019 | ||||||||
| LastUpdateDate: | 06/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | POLLACHEK | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7088058900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.