Provider Demographics
NPI:1780847350
Name:PROFESSIONAL ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:FELDERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:816-616-2512
Mailing Address - Street 1:P.O. BOX 790343
Mailing Address - Street 2:BIN # 150054
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0343
Mailing Address - Country:US
Mailing Address - Phone:913-754-0467
Mailing Address - Fax:913-341-5797
Practice Address - Street 1:2111 N WOODBINE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2440
Practice Address - Country:US
Practice Address - Phone:816-616-2512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1240Medicare PIN