Basic Information
| Provider Information | |||||||||
| NPI: | 1336361922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMSOL ANESTHETISTS OF LITCHFIELD IL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 610201 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752610201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003944445 | ||||||||
| FaxNumber: | 2053221851 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 FRANCISCAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620561778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173242191 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | EICHENHOLZ | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2146870001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
ID Information
| ID | Type | State | Issuer | Description | 06832024 | 01 | IL | BLUE CROSS | OTHER |