Provider Demographics
NPI:1225073828
Name:PREMIER ANESTHESIA LLC
Entity Type:Organization
Organization Name:PREMIER ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOROUGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-200-1462
Mailing Address - Street 1:760 OFFICE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7105
Mailing Address - Country:US
Mailing Address - Phone:314-200-1462
Mailing Address - Fax:314-942-1613
Practice Address - Street 1:760 OFFICE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7105
Practice Address - Country:US
Practice Address - Phone:314-200-1462
Practice Address - Fax:314-942-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207L00000X, 208VP0000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty