Provider Demographics
NPI:1922053651
Name:IDEAL ANESTHESIA SERVICES PC
Entity Type:Organization
Organization Name:IDEAL ANESTHESIA SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:847-989-8635
Mailing Address - Street 1:126 E WING ST # 182
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6064
Mailing Address - Country:US
Mailing Address - Phone:866-839-7136
Mailing Address - Fax:866-245-7239
Practice Address - Street 1:126 E WING ST # 182
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6064
Practice Address - Country:US
Practice Address - Phone:866-839-7136
Practice Address - Fax:866-245-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003040367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200614Medicare ID - Type UnspecifiedGROUP #
IL200613Medicare ID - Type UnspecifiedGROUP #
WI21220Medicare ID - Type UnspecifiedGROUP #
IL200615Medicare ID - Type UnspecifiedGROUP #