Basic Information
| Provider Information | |||||||||
| NPI: | 1659384188 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST JOSEPH ANESTHESIA SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10310 STATE LINE RD STE A | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662062695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136474101 | ||||||||
| FaxNumber: | 9136474121 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 CARONDELET DR | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641144673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169432252 | ||||||||
| FaxNumber: | 8169434656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8169432252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 07990011 | 01 | MO | BCBS OF KANSAS CITY | OTHER |