MEDICARE: ST. LOUIS AMBULATORY ANESTHESIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1194065268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LOUIS AMBULATORY ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	5930 ROYAL LN STE E #350
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3896
Country	:	US
Telephone Number	:	888-559-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	14705 WHITE LANE CT
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-7955
Country	:	US
Telephone Number	:	888-559-2666
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOE SLIMACK
Credential	:	MD
Telephone Number	:	314-575-1745

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	03/01/2013

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