Provider Demographics
NPI:1699724781
Name:STAT ANESTHESIA SPECIALISTS LTD
Entity type:Organization
Organization Name:STAT ANESTHESIA SPECIALISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLACHEK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:708-805-8900
Mailing Address - Street 1:18221 TORRENCE AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2870
Mailing Address - Country:US
Mailing Address - Phone:708-895-9450
Mailing Address - Fax:708-895-9455
Practice Address - Street 1:10220 WICKER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9424
Practice Address - Country:US
Practice Address - Phone:219-515-6943
Practice Address - Fax:708-895-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2017-11-21
Deactivation Date:2013-08-28
Deactivation Code:
Reactivation Date:2013-10-23
Provider Licenses
StateLicense IDTaxonomies
IL64718096207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty