1801161898 NPI number — MID-AMERICA ANESTHESIA SERVICES, LLC

Table of content: DAVID ALAN NISHIDA PT CSCS (NPI 1265409627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801161898 NPI number — MID-AMERICA ANESTHESIA SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-AMERICA ANESTHESIA SERVICES, LLC
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:
Provider Other Organization Name Type Code:
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:
1801161898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 OLD HIGHWAY 63 S
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-6092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-875-8838
Provider Business Mailing Address Fax Number:
573-875-8589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 W NIFONG BLVD
Provider Second Line Business Practice Location Address:
BLDG 6 #130
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65203-5615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-875-8838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
573-875-8838

Provider Taxonomy Codes

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

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





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