Provider Demographics
NPI:1841383171
Name:MCALESTER ANESTHESIA AND RESPIRATORY SERVICES, INC
Entity Type:Organization
Organization Name:MCALESTER ANESTHESIA AND RESPIRATORY SERVICES, INC
Other - Org Name:MCALESTER PAIN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-421-8897
Mailing Address - Street 1:4 E CLARK BASS BLVD
Mailing Address - Street 2:SUITE # 205
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4285
Mailing Address - Country:US
Mailing Address - Phone:918-421-8897
Mailing Address - Fax:918-302-0825
Practice Address - Street 1:4 E CLARK BASS BLVD
Practice Address - Street 2:SUITE # 205
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4285
Practice Address - Country:US
Practice Address - Phone:918-421-8897
Practice Address - Fax:918-302-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100736010AMedicaid
OK=========-003OtherBC/BS OF OKLAHOMA
OK100736010AMedicaid