Basic Information
Provider Information
NPI: 1982605127
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARROTT
FirstName: EDMUND
MiddleName: W
NamePrefix: MR.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 351 CONSORT DR
Address2:  
City: BALLWIN
State: MO
PostalCode: 630114439
CountryCode: US
TelephoneNumber: 6362004242
FaxNumber: 6362004243
Practice Location
Address1: 17050 BAXTER RD
Address2: CHESTERFIELD SURGERY CTR. - SUITE 110
City: CHESTERFIELD
State: MO
PostalCode: 630051422
CountryCode: US
TelephoneNumber: 6365370122
FaxNumber: 6365370480
Other Information
ProviderEnumerationDate: 08/10/2005
LastUpdateDate: 10/30/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X087971MOY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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