Basic Information
| Provider Information | |||||||||
| NPI: | 1013961515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANGAMON ASSOCIATED ANESTHESIOLOGISTS, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 EAST CARPENTER STREET | ||||||||
| Address2: | ROOM 2K64 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627690001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175255643 | ||||||||
| FaxNumber: | 2175443311 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 EAST CARPENTER STREET | ||||||||
| Address2: | ROOM 2K64 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627690001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175255643 | ||||||||
| FaxNumber: | 2175443311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | GHERMANN | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2175255643 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 207L00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.