Provider Demographics
NPI: | 1003151960 |
---|---|
Name: | SOUTHEAST ANESTHESIA SERVICES |
Entity Type: | Organization |
Organization Name: | SOUTHEAST ANESTHESIA SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | V PRES CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | HUBERT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 573-331-6882 |
Mailing Address - Street 1: | 1701 LACEY ST |
Mailing Address - Street 2: | |
Mailing Address - City: | CAPE GIRARDEAU |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 63701-5230 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 573-331-6882 |
Mailing Address - Fax: | 573-331-6887 |
Practice Address - Street 1: | 1701 LACEY ST |
Practice Address - Street 2: | |
Practice Address - City: | CAPE GIRARDEAU |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63701-5230 |
Practice Address - Country: | US |
Practice Address - Phone: | 573-331-6882 |
Practice Address - Fax: | 573-331-6887 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | SOUTHEAST MISSOURI HOSPITAL PHYSICIANS LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2012-12-04 |
Last Update Date: | 2012-12-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty |