Provider Demographics
NPI:1841704525
Name:JANICKI ANESTHESIA SERVICES PC
Entity type:Organization
Organization Name:JANICKI ANESTHESIA SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:JANICKI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:708-935-1921
Mailing Address - Street 1:95 N PECK AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5829
Mailing Address - Country:US
Mailing Address - Phone:708-935-1921
Mailing Address - Fax:
Practice Address - Street 1:10500 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5205
Practice Address - Country:US
Practice Address - Phone:708-424-1202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty