Basic Information
| Provider Information | |||||||||
| NPI: | 1508922790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREFERRED ANESTHESIA SERVICES P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 527 COURTLAND AVE | ||||||||
| Address2: | |||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600684827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125628633 | ||||||||
| FaxNumber: | 8476924916 | ||||||||
| Practice Location | |||||||||
| Address1: | 1455 E GOLF RD | ||||||||
| Address2: | |||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600161250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473907666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 01/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | TOPEL | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3125628633 | ||||||||
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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 | 207L00000X | 109961-030 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0001606018 | 01 | IL | BCBS OF IL | OTHER |