Provider Demographics
NPI:1346353661
Name:SOUTHERN ILLINOIS ANESTHESIOLOGY LTD
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS ANESTHESIOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:M
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-241-1108
Mailing Address - Street 1:4227 LINCOLNSHIRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2157
Mailing Address - Country:US
Mailing Address - Phone:618-242-2317
Mailing Address - Fax:618-242-9710
Practice Address - Street 1:605 N 12TH STREET
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2857
Practice Address - Country:US
Practice Address - Phone:618-241-1108
Practice Address - Fax:618-241-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL42617784207L00000X, 207LP2900X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
203929Medicare ID - Type Unspecified
203931Medicare ID - Type Unspecified