Basic Information
| Provider Information | |||||||||
| NPI: | 1013958461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIASA ANESTHESIA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE MEMORIAL DR | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 16200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184657177 | ||||||||
| FaxNumber: | 6184657176 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE MEMORIAL DR | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 16200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184657177 | ||||||||
| FaxNumber: | 6184657176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRUMMETT | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6184657177 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 208VP0000X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.