Provider Demographics
NPI:1093805517
Name:TALCOTT ANESTHESIOLOGISTS, S.C.
Entity Type:Organization
Organization Name:TALCOTT ANESTHESIOLOGISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:847-696-9015
Mailing Address - Street 1:444 N. NORTHWEST HWY.
Mailing Address - Street 2:SUITE # 302
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3277
Mailing Address - Country:US
Mailing Address - Phone:847-696-9015
Mailing Address - Fax:847-696-9017
Practice Address - Street 1:7435 W TALCOTT AVE
Practice Address - Street 2:RMC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3707
Practice Address - Country:US
Practice Address - Phone:773-792-5162
Practice Address - Fax:773-594-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001620300OtherGROUPBC/BS OF ILLINOIS ID
IL=========OtherGROUP TAX ID
IL381680Medicare ID - Type UnspecifiedGROUP PROVIDER ID