Provider Demographics
NPI:1073545265
Name:ANESTHESIA ASSOCIATES OF JEFFERSON COUNTY
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF JEFFERSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-933-1000
Mailing Address - Street 1:HIGHWAY 61 S. AT HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:CRYATAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019
Mailing Address - Country:US
Mailing Address - Phone:636-933-1000
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 61 S. AT HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:CRYATAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019
Practice Address - Country:US
Practice Address - Phone:636-933-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO129208OtherBLUE SHIELD
MOCH0419OtherRR MEDICARE
MO13319Medicare ID - Type Unspecified