Provider Demographics
NPI:1083642003
Name:ANESTHESIA ASSOCIATES OF ST. LOUIS, INC.
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF ST. LOUIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HANY
Authorized Official - Middle Name:B
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-424-3829
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0125
Mailing Address - Country:US
Mailing Address - Phone:888-731-1036
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:ONE MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-463-7311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6032302OtherBCBS OF IL
MO203133OtherBCBS OF MO
MO500567102Medicaid
ILDO9360OtherRAILROAD MEDICARE
IL1083642003Medicaid
IL215538Medicare PIN
MO203133OtherBCBS OF MO