Provider Demographics
NPI:1386728236
Name:ANESTHESIA ASSOCIATES OF CRYSTAL VALLEY, S. C.
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF CRYSTAL VALLEY, S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-385-0084
Mailing Address - Street 1:4309 W MEDICAL CENTER DR
Mailing Address - Street 2:SUITE A201
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8419
Mailing Address - Country:US
Mailing Address - Phone:815-385-0084
Mailing Address - Fax:815-385-8968
Practice Address - Street 1:4309 W MEDICAL CENTER DR
Practice Address - Street 2:SUITE A201
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8419
Practice Address - Country:US
Practice Address - Phone:815-385-0084
Practice Address - Fax:815-385-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-006676207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty