Provider Demographics
NPI:1689821449
Name:RELIABLE ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:RELIABLE ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-779-8499
Mailing Address - Street 1:10323 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1610
Mailing Address - Country:US
Mailing Address - Phone:773-779-8499
Mailing Address - Fax:773-429-9972
Practice Address - Street 1:10323 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1610
Practice Address - Country:US
Practice Address - Phone:773-779-8499
Practice Address - Fax:773-429-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-24
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088163207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088163Medicaid
ILIL1749Medicare PIN
IL036088163Medicaid