Provider Demographics
NPI:1578203733
Name:QC SUPPLEMENTAL ANESTHESIA STAFFING LLC
Entity Type:Organization
Organization Name:QC SUPPLEMENTAL ANESTHESIA STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHIRANJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-714-7991
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0689
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:
Practice Address - Street 1:4500 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1626
Practice Address - Country:US
Practice Address - Phone:563-742-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty