Provider Demographics
NPI:1508922790
Name:PREFERRED ANESTHESIA SERVICES P C
Entity Type:Organization
Organization Name:PREFERRED ANESTHESIA SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPEL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:312-562-8633
Mailing Address - Street 1:527 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4827
Mailing Address - Country:US
Mailing Address - Phone:312-562-8633
Mailing Address - Fax:847-692-4916
Practice Address - Street 1:1455 E GOLF RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1250
Practice Address - Country:US
Practice Address - Phone:847-390-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI109961-030207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001606018OtherBCBS OF IL
WI=========015OtherBCBS OF WI
ILIL4322Medicare PIN
WI21638Medicare ID - Type UnspecifiedMEDICARE WI
IL958361Medicare ID - Type UnspecifiedMEDICARE IL