Organization
EPIX ANESTHESIA OF CENTRAL ILLINOIS LLC
Active
Organization
EPIX ANESTHESIA OF CENTRAL ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH PRUITT M.D. (OWNER)
(678) 580-1349
Entity
Organization
Contact information
Practice address
12935 GREGORY ST, BLUE ISLAND, IL 60406-2428
(678) 580-1349
(770) 559-1231
Mailing address
1080 HOLCOMB BRIDGE RD STE 330, ROSWELL, GA 30076-4346
(678) 580-1349
(770) 559-1231
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
10/07/2013
Last updated
06/24/2020
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