Provider Demographics
NPI:1619210762
Name:BELMONT HARLEM ANESTHESIA LLC
Entity Type:Organization
Organization Name:BELMONT HARLEM ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-537-1720
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-0631
Mailing Address - Country:US
Mailing Address - Phone:847-615-2200
Mailing Address - Fax:
Practice Address - Street 1:3101 N HARLEM AVE
Practice Address - Street 2:BELMONT HARLEM SURGERY CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4543
Practice Address - Country:US
Practice Address - Phone:773-889-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207L00000XOtherTAXONOMY