Basic Information
| Provider Information | |||||||||
| NPI: | 1073545265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA ASSOCIATES OF JEFFERSON COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | HIGHWAY 61 S. AT HIGHWAY 67 | ||||||||
| Address2: | |||||||||
| City: | CRYATAL CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369331000 | ||||||||
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| Practice Location | |||||||||
| Address1: | HIGHWAY 61 S. AT HIGHWAY 67 | ||||||||
| Address2: | |||||||||
| City: | CRYATAL CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369331000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRES | ||||||||
| AuthorizedOfficialTelephone: | 6369331000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 129208 | 01 | MO | BLUE SHIELD | OTHER | CH0419 | 01 | MO | RR MEDICARE | OTHER |