Provider Demographics
NPI:1336128933
Name:MD ANESTHESIA SERVICES SC
Entity Type:Organization
Organization Name:MD ANESTHESIA SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DZIAMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-762-9711
Mailing Address - Street 1:1634 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4860
Mailing Address - Country:US
Mailing Address - Phone:309-762-9711
Mailing Address - Fax:309-762-9747
Practice Address - Street 1:1634 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4860
Practice Address - Country:US
Practice Address - Phone:309-762-9711
Practice Address - Fax:309-762-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095969207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095969Medicaid
G64712Medicare UPIN
IL036095969Medicaid
DB4771Medicare PIN