Organization
COLLINS AMBULATORY ANESTHESIA SERVICES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY COLLINS M.D. (PRESIDENT)
(618) 973-5189
Entity
Organization
Contact information
Practice address
106 FRIARS LN, EDWARDSVILLE, IL 62025-3876
(618) 973-5189
Mailing address
106 FRIARS LN, EDWARDSVILLE, IL 62025-3876
(618) 973-5189
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036079652
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770804452
—
IL
Enumeration date
03/04/2011
Last updated
03/04/2011
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