Airway Anesthesia PC
Organization Active NPI Anesthesiology Physician · Normal, IL
NPI 1992064166 · NPPES record last updated Apr 30, 2015
Key facts
- NPI
- 1992064166
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 209-001108 (IL)
- Legal business name
- AIRWAY ANESTHESIA PC
- Practice address
- 1105 Sterling Glen CC CT
Normal, IL 61761-5297 - Phone
- (309) 454-4617
- Fax
- (877) 757-6325
- NPI assigned
- May 9, 2012
- Organization subpart
- No
Authorized official
- Name
- Daryl D Chenoweth, CRNA
- Title
- Director
- Phone
- (309) 454-4617
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | 209-001108 | IL | Yes |
Addresses
Primary practice location
1105 Sterling Glen CC CT
Normal, IL 61761-5297
Mailing address
1105 Sterling Glen CC CT
Normal, IL 61761-5297
Phone (309) 454-4617
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 617834300 | Other | IL | DEPT OF LABOR |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.