Provider Demographics
NPI:1023016714
Name:HANNIBAL ANESTHESIA ASSOCIATES LLC
Entity Type:Organization
Organization Name:HANNIBAL ANESTHESIA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-406-1301
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-0511
Mailing Address - Country:US
Mailing Address - Phone:573-406-1301
Mailing Address - Fax:573-406-0511
Practice Address - Street 1:98 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-406-1301
Practice Address - Fax:573-406-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1037OtherBLUE CROSS/BLUE SHIELD
MO406428OtherHEALTHLINK
MO505377903Medicaid
MO1037OtherBLUE CROSS/BLUE SHIELD
MO1037OtherBLUE CROSS/BLUE SHIELD
MOCH8435Medicare ID - Type UnspecifiedRAILROAD MEDICARE