Provider Demographics
NPI:1558306480
Name:ASSOCIATED ANESTHESIOLOGISTS, S.C.
Entity Type:Organization
Organization Name:ASSOCIATED ANESTHESIOLOGISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFORMATION SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARY HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-692-5393
Mailing Address - Street 1:6742 N FROSTWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2402
Mailing Address - Country:US
Mailing Address - Phone:309-692-5393
Mailing Address - Fax:309-683-9998
Practice Address - Street 1:6742 N FROSTWOOD PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2402
Practice Address - Country:US
Practice Address - Phone:309-692-5393
Practice Address - Fax:309-668-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL614451Medicare ID - Type UnspecifiedCRNA MEDICARE GROUP#
IL614450Medicare ID - Type UnspecifiedPHYSICIAN MEDICARE GROUP#
ILCK0860Medicare PIN
ILCJ4547Medicare PIN