Provider Demographics
NPI:1942596002
Name:PHYSICIANS' AMBULATORY ANESTHESIA SERVICES, LLC
Entity Type:Organization
Organization Name:PHYSICIANS' AMBULATORY ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-283-8498
Mailing Address - Street 1:1860 GATEMONT DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8012
Mailing Address - Country:US
Mailing Address - Phone:314-283-8498
Mailing Address - Fax:636-220-4132
Practice Address - Street 1:12266 DEPAUL DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2514
Practice Address - Country:US
Practice Address - Phone:314-291-7500
Practice Address - Fax:314-291-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty