Brigham Anesthesia South LLC
Anesthesiology in Carbondale, IL. Organization (NPI-2).
NPI number1699769232
StatusActive
Last updated in NPPESAug 4, 2011
Details
- NPI
- 1699769232
- Entity type
- Organization (NPI-2)
- Legal business name
- Brigham Anesthesia South LLC
- Organization subpart
- No
- Enumeration date
- Sep 9, 2005
- Last updated
- Aug 4, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207L00000X | Anesthesiology | – | – | Yes |
Practice location
405 W Jackson StMemorial Hospital Of Carbondale
Carbondale, IL 62901-1462
Phone 618-549-0721 · Fax 618-351-4849
Mailing address
35 Albany RdSuite C
Carbondale, IL 62903-7605
Phone 618-457-5111 · Fax 618-457-6560
Authorized official
Gardner Thomas Kenny
Managing Member
6184575111
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