Healthcare Provider Details

I. General information

NPI: 1013973296
Provider Name (Legal Business Name): WHITE RIVER ANESTHESIA ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BRANSON LANDING BLVD
BRANSON MO
65616-2052
US

IV. Provider business mailing address

PO BOX 842120
KANSAS CITY MO
64184-2120
US

V. Phone/Fax

Practice location:
  • Phone: 417-239-3392
  • Fax: 417-239-3394
Mailing address:
  • Phone: 800-277-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB K. LUDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 417-239-3392