Provider Demographics
NPI:1518227461
Name:MOBILE ANESTHESIOLOGISTS
Entity Type:Organization
Organization Name:MOBILE ANESTHESIOLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MISS
Authorized Official - First Name:KINGA
Authorized Official - Middle Name:AGATA
Authorized Official - Last Name:RYDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-269-6688
Mailing Address - Street 1:1839 W LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4405
Mailing Address - Country:US
Mailing Address - Phone:847-269-6688
Mailing Address - Fax:
Practice Address - Street 1:1839 W LOCUST LN
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4405
Practice Address - Country:US
Practice Address - Phone:847-269-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041359374314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.359374OtherRN