Provider Demographics
NPI:1003207580
Name:ANESTHESIA SERVICES OF MID MISSOURI
Entity Type:Organization
Organization Name:ANESTHESIA SERVICES OF MID MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGARITY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-239-4148
Mailing Address - Street 1:1410 FORUM KATY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6325
Mailing Address - Country:US
Mailing Address - Phone:573-397-6556
Mailing Address - Fax:573-397-6557
Practice Address - Street 1:112 BINGHAM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3578
Practice Address - Country:US
Practice Address - Phone:573-397-6556
Practice Address - Fax:573-397-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018602207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty