Provider Demographics
NPI:1518929157
Name:MID-MISSOURI ANESTHESIOLOGISTS, INC.
Entity Type:Organization
Organization Name:MID-MISSOURI ANESTHESIOLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-445-7300
Mailing Address - Street 1:PO BOX 843104
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-0001
Mailing Address - Country:US
Mailing Address - Phone:573-445-7300
Mailing Address - Fax:573-445-7301
Practice Address - Street 1:ONE SOUTH KEENE STREET
Practice Address - Street 2:THE SURGICAL CENTER AT COLUMBIA ORTHOPAEDIC GROUP
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-445-7300
Practice Address - Fax:573-445-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2011-01-26
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
MOCC7976OtherRAILROAD MEDICARE
MO138147OtherHEALTH LINK
MO503021701Medicaid
MO1360OtherBCBS RIGHT CHOICE
MOCC7976OtherRAILROAD MEDICARE