Basic Information
| Provider Information | |||||||||
| NPI: | 1366693293 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA CONSULTANTS OF JEFFERSON COUNTY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 HAYS HILL DR | ||||||||
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| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630263159 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 W GANNON DR | ||||||||
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| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630282602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369315997 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2008 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHMITT | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6364587537 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 066039 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.