Basic Information
| Provider Information | |||||||||
| NPI: | 1326091059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-MISSOURI ANESTHESIA CONSULTANTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1445 CHRISTY DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651012853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736363483 | ||||||||
| FaxNumber: | 5736365315 | ||||||||
| Practice Location | |||||||||
| Address1: | 1445 CHRISTY DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651012853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736363483 | ||||||||
| FaxNumber: | 5736365315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | BUSCHJOST | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5736363483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | MO | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.