Provider Demographics
NPI:1700218146
Name:BELLEVILLE ENDOSCOPY ANESTHESIA
Entity Type:Organization
Organization Name:BELLEVILLE ENDOSCOPY ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-233-3661
Mailing Address - Street 1:311 W LINCOLN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1902
Mailing Address - Country:US
Mailing Address - Phone:618-233-3661
Mailing Address - Fax:618-233-0992
Practice Address - Street 1:311 W LINCOLN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1902
Practice Address - Country:US
Practice Address - Phone:618-233-3661
Practice Address - Fax:618-233-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty