Provider Demographics
NPI:1811936230
Name:CJB ANESTHESIA SERVICES INC
Entity type:Organization
Organization Name:CJB ANESTHESIA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERGBOWER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:618-546-2410
Mailing Address - Street 1:7797 E 1050TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-4734
Mailing Address - Country:US
Mailing Address - Phone:618-544-3131
Mailing Address - Fax:
Practice Address - Street 1:1000 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1167
Practice Address - Country:US
Practice Address - Phone:618-544-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020354300OtherBLACK LUNG
IL01732004OtherBLUE CROSS BLUE SHIELD
ILDA2630OtherRAILROAD MEDICARE GROUP #
IL206217Medicare ID - Type UnspecifiedGROUP NUMBER