Provider Demographics
NPI:1669498085
Name:KIRKSVILLE ANESTHESIA ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:KIRKSVILLE ANESTHESIA ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROOF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-785-1000
Mailing Address - Street 1:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0702
Mailing Address - Country:US
Mailing Address - Phone:660-785-1000
Mailing Address - Fax:660-785-1237
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:NORTHEAST REGIONAL MEDICAL CENTER
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-785-1000
Practice Address - Fax:660-785-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205OtherBLUE CROSS, BLUE SHIELD
MO8298OtherHEALTHCARE USA
CG4336OtherRAILROAD MEDICARE
IA0976845Medicaid
MO503208209Medicaid
299013OtherBLACK LUNG
MO503208209Medicaid
IA0976845Medicaid