Provider Demographics
NPI:1457778169
Name:MOBILE ANESTHESIA CARE, LLC
Entity Type:Organization
Organization Name:MOBILE ANESTHESIA CARE, LLC
Other - Org Name:MOBILE ANESTHESIA CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINDSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-428-2900
Mailing Address - Street 1:8717 W 110TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2144
Mailing Address - Country:US
Mailing Address - Phone:913-428-2900
Mailing Address - Fax:913-428-2951
Practice Address - Street 1:8717 W 110TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2144
Practice Address - Country:US
Practice Address - Phone:913-428-2900
Practice Address - Fax:913-428-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100000590BMedicaid
MO00053011OtherBLUECROSS/BLUESHIELD
MO500513601Medicaid
KS100000590AMedicaid