Provider Demographics
NPI:1396831715
Name:MACEREN ANESTHESIOLOGY ASSOCIATE INC.
Entity Type:Organization
Organization Name:MACEREN ANESTHESIOLOGY ASSOCIATE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACEREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-933-6569
Mailing Address - Street 1:2 HOWE XING
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4044
Mailing Address - Country:US
Mailing Address - Phone:636-933-6569
Mailing Address - Fax:636-933-6569
Practice Address - Street 1:2 HOWE XING
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4044
Practice Address - Country:US
Practice Address - Phone:636-933-6569
Practice Address - Fax:636-933-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6445207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty