1275646754 NPI number — WESTERN ANESTHESIOLOGY ASSOCIATES, INC.

Table of content: (NPI 1275646754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275646754 NPI number — WESTERN ANESTHESIOLOGY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN ANESTHESIOLOGY ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WESTERN ANESTHESIOLOGY PAIN MANAGEMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275646754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
339 CONSORT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63011-4439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-386-9224
Provider Business Mailing Address Fax Number:
636-386-7679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 S NEW BALLAS RD
Provider Second Line Business Practice Location Address:
DEPT. OF ANESTHESIA
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-8221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-386-9224
Provider Business Practice Location Address Fax Number:
636-386-7679
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHANS
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
636-386-9224

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500477500 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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