Provider Demographics
NPI:1851010417
Name:GI ALLIANCE ANESTHESIA OF MISSOURI
Entity Type:Organization
Organization Name:GI ALLIANCE ANESTHESIA OF MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIA SUPPORT SERVICE COORDINA
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-402-7526
Mailing Address - Street 1:550 RESERVE ST STE 560
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1607
Mailing Address - Country:US
Mailing Address - Phone:817-402-7526
Mailing Address - Fax:
Practice Address - Street 1:17501 E US HIGHWAY 40 STE 213A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6445
Practice Address - Country:US
Practice Address - Phone:816-478-4887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty