Provider Demographics
NPI:1659384188
Name:ST JOSEPH ANESTHESIA SERVICES, P.C.
Entity Type:Organization
Organization Name:ST JOSEPH ANESTHESIA SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-943-2252
Mailing Address - Street 1:10310 STATE LINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2695
Mailing Address - Country:US
Mailing Address - Phone:913-647-4101
Mailing Address - Fax:913-647-4121
Practice Address - Street 1:1000 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:816-943-2252
Practice Address - Fax:816-943-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO07990011OtherBCBS OF KANSAS CITY
MO07990011OtherBCBS OF KANSAS CITY
MO4950000Medicare ID - Type Unspecified