Provider Demographics
NPI:1780831107
Name:AMBULATORY ANESTHESIA SERVICES OF MISSOURI LLC
Entity type:Organization
Organization Name:AMBULATORY ANESTHESIA SERVICES OF MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-934-0386
Mailing Address - Street 1:PO BOX 31518
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-0518
Mailing Address - Country:US
Mailing Address - Phone:314-394-0386
Mailing Address - Fax:
Practice Address - Street 1:1531 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2925
Practice Address - Country:US
Practice Address - Phone:417-627-9699
Practice Address - Fax:417-627-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-12-02
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