Provider Demographics
NPI:1639333925
Name:ROUNDTRIP ANESTHESIA, INC.
Entity Type:Organization
Organization Name:ROUNDTRIP ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ANESTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:312-401-3568
Mailing Address - Street 1:2150 W POTOMAC AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3010
Mailing Address - Country:US
Mailing Address - Phone:312-401-3568
Mailing Address - Fax:773-661-1194
Practice Address - Street 1:2150 W POTOMAC AVE
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3010
Practice Address - Country:US
Practice Address - Phone:312-401-3568
Practice Address - Fax:773-661-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.005990261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service