Provider Demographics
NPI:1740599752
Name:NORTHSIDE ANESTHESIA, LLC
Entity Type:Organization
Organization Name:NORTHSIDE ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD CRNA
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:773-383-0776
Mailing Address - Street 1:9315 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1308
Mailing Address - Country:US
Mailing Address - Phone:773-383-0776
Mailing Address - Fax:847-859-5852
Practice Address - Street 1:9315 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60203-1308
Practice Address - Country:US
Practice Address - Phone:773-383-0776
Practice Address - Fax:847-859-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-26
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty