Provider Demographics
NPI:1053662932
Name:ANESTHESIA OF SOUTHERN ILLINOIS LLC
Entity Type:Organization
Organization Name:ANESTHESIA OF SOUTHERN ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-698-4021
Mailing Address - Street 1:2810 FRANK SCOTT PKWY W STE 716
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5007
Mailing Address - Country:US
Mailing Address - Phone:618-355-0880
Mailing Address - Fax:618-355-0881
Practice Address - Street 1:2810 FRANK SCOTT PKWY W STE 716
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5007
Practice Address - Country:US
Practice Address - Phone:618-355-0880
Practice Address - Fax:618-355-0881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VASANTHA PAI, MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-02
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty