Provider Demographics
NPI:1225189160
Name:WOODS MILL ANESTHESIA, INC.
Entity Type:Organization
Organization Name:WOODS MILL ANESTHESIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-284-6396
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-0005
Mailing Address - Country:US
Mailing Address - Phone:314-895-3828
Mailing Address - Fax:314-895-3827
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:314-895-3828
Practice Address - Fax:314-895-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-01-09
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
CD0710OtherRAILROAD MEDICARE
CF9682OtherRAILROAD MEDICARE
CM0398OtherRAILROAD MEDICARE
MO000011761OtherMEDICARE PTAN
MO507732303Medicaid
CD0710OtherRAILROAD MEDICARE