Organization
ASSOCIATED ANESTHESIOLOGISTS OF DECATUR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE OSTRANDER MD (PRESIDENT)
(217) 876-8121
Entity
Organization
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-8121
Mailing address
PO BOX 25137, DECATUR, IL 62525-5137
(800) 897-6169
(800) 897-6170
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05815161
BLUE CROSS OF IL
IL
Enumeration date
01/05/2006
Last updated
02/13/2014
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