Basic Information
| Provider Information | |||||||||
| NPI: | 1821199480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEAVER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1209 NW NORTH RIDGE DR STE B | ||||||||
| Address2: | ANESTHESIA SERVICES OF BLUE SPRINGS | ||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640156320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169888415 | ||||||||
| FaxNumber: | 8169888395 | ||||||||
| Practice Location | |||||||||
| Address1: | 1209 NW NORTH RIDGE DR STE B | ||||||||
| Address2: | ANESTHESIA SERVICES OF BLUE SPRINGS | ||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640156320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169888415 | ||||||||
| FaxNumber: | 8169888395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 07/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | R4A24 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 202951521 | 05 | MO | MEDICAID |