| NPI | 1558425462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE FANCHER President 217-464-5839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207LC0200X Anesthesiology Critical Care Medicine | |
| 207LP3000X Anesthesiology Pediatric Anesthesiology | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2013-01-31 |