Basic Information
| Provider Information | |||||||||
| NPI: | 1003300286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCY CARTHAGE ANESTHESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 DR RUSSELL SMITH WAY | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648367402 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3125 DR RUSSELL SMITH WAY | ||||||||
| Address2: | |||||||||
| City: | CARTHAGE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648367402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173588121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2018 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4173592653 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MERCY HOSPITAL CARTHAGE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.