Provider Demographics
NPI:1790797710
Name:ANESTHESIA ADVOCATES, PC
Entity Type:Organization
Organization Name:ANESTHESIA ADVOCATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGNICH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:815-320-3086
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-0367
Mailing Address - Country:US
Mailing Address - Phone:815-320-3086
Mailing Address - Fax:815-464-1767
Practice Address - Street 1:1210 CROWN FOX LN
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1205
Practice Address - Country:US
Practice Address - Phone:815-320-3086
Practice Address - Fax:815-464-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL120963600OtherDEPT OF LABOR
ILCK3979OtherRAILROAD MEDICARE
IL9932061OtherBCBS
IL120963600OtherDEPT OF LABOR
IL216044Medicare PIN
ILCK3979OtherRAILROAD MEDICARE