Provider Demographics
NPI:1043757487
Name:ANESTHESIA ASSOCIATES OF SOUTHERN ILLINOIS SURGERY CENTER LLC
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF SOUTHERN ILLINOIS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOPFENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-368-5849
Mailing Address - Street 1:2 GOOD SAMARITAN WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2408
Mailing Address - Country:US
Mailing Address - Phone:618-899-3869
Mailing Address - Fax:618-899-3558
Practice Address - Street 1:2 GOOD SAMARITAN WAY STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2476
Practice Address - Country:US
Practice Address - Phone:618-899-5703
Practice Address - Fax:618-899-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty