Provider Demographics
NPI:1821843418
Name:EQUANIMITY ANESTHESIA SERVICES, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:EQUANIMITY ANESTHESIA SERVICES, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:LAVER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:312-388-4440
Mailing Address - Street 1:11 ANN ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-8807
Mailing Address - Country:US
Mailing Address - Phone:312-388-4440
Mailing Address - Fax:
Practice Address - Street 1:11 ANN ARBOR CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61705-8807
Practice Address - Country:US
Practice Address - Phone:312-388-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty