Healthcare Provider Details

I. General information

NPI: 1558393728
Provider Name (Legal Business Name): JAMES E SPALDING CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WEST LINCOLN SUITE 300
BELLEVILLE IL
62220-1921
US

IV. Provider business mailing address

13523 BARRETT PARKWAY DRIVE SUITE 104
BALLWIN MO
63021-3802
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7077
  • Fax:
Mailing address:
  • Phone: 636-938-6868
  • Fax: 636-938-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209-000239
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209000239
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: