Provider Demographics
NPI:1740873033
Name:ASC ANESTHESIA LLC
Entity type:Organization
Organization Name:ASC ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-332-7881
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-0817
Mailing Address - Country:US
Mailing Address - Phone:573-332-7881
Mailing Address - Fax:573-332-7176
Practice Address - Street 1:300 S MOUNT AUBURN RD STE 200
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4902
Practice Address - Country:US
Practice Address - Phone:573-332-7881
Practice Address - Fax:573-332-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty