Provider Demographics
NPI:1972878460
Name:ANESTHESIA ASSOCIATES OF SOUTHERN ILLINOIS, LLC
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF SOUTHERN ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-899-3869
Mailing Address - Street 1:2700 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 DOCTORS PARK RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6224
Practice Address - Country:US
Practice Address - Phone:618-244-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty