Provider Demographics
NPI:1720040165
Name:MISSOURI VALLEY ANESTHESIA, PC
Entity Type:Organization
Organization Name:MISSOURI VALLEY ANESTHESIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-239-8090
Mailing Address - Street 1:601 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1986
Mailing Address - Country:US
Mailing Address - Phone:859-291-4800
Mailing Address - Fax:859-655-8588
Practice Address - Street 1:901 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3127
Practice Address - Country:US
Practice Address - Phone:636-239-8090
Practice Address - Fax:636-390-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty