Provider Demographics
NPI:1366517583
Name:PREMIER ANESTHESIA OF DANVILLE
Entity type:Organization
Organization Name:PREMIER ANESTHESIA OF DANVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-443-5000
Mailing Address - Street 1:PO BOX 532904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-2904
Mailing Address - Country:US
Mailing Address - Phone:217-443-5000
Mailing Address - Fax:
Practice Address - Street 1:812 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3752
Practice Address - Country:US
Practice Address - Phone:217-443-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ09232012OtherBCBS OF IL
AZDA4244OtherRAILROAD MEDICARE
AZ205649Medicare PIN
AZDA4244OtherRAILROAD MEDICARE