Provider Demographics
NPI:1467634097
Name:AMBULATORY ANESTHESIA SERVICES OF ST. CHARLES, LLC
Entity type:Organization
Organization Name:AMBULATORY ANESTHESIA SERVICES OF ST. CHARLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAKADANDILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-346-6051
Mailing Address - Street 1:13523 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-3802
Mailing Address - Country:US
Mailing Address - Phone:314-775-2816
Mailing Address - Fax:314-775-2821
Practice Address - Street 1:4203 S CLOVERLEAF DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6452
Practice Address - Country:US
Practice Address - Phone:636-346-6051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty