Basic Information
Provider Information | |||||||||
NPI: | 1588032742 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ANESTHESIA ASSOCIATES OF JOPLIN LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
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Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
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OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
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OtherCredential: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 1A BURTON HILLS BLVD | ||||||||
Address2: | ATTN: | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372156187 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6152403809 | ||||||||
FaxNumber: | 6152341809 | ||||||||
Practice Location | |||||||||
Address1: | 1531 E 32ND ST | ||||||||
Address2: | SUITE 6 | ||||||||
City: | JOPLIN | ||||||||
State: | MO | ||||||||
PostalCode: | 648042911 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4176279699 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/04/2015 | ||||||||
LastUpdateDate: | 08/09/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CLENDENIN | ||||||||
AuthorizedOfficialFirstName: | PHILLIP | ||||||||
AuthorizedOfficialMiddleName: | A. | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 6156651283 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.