Healthcare Provider Details

I. General information

NPI: 1114917374
Provider Name (Legal Business Name): NORTHWEST ANESTHESIA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

12303 DE PAUL DR
BRIDGETON MO
63044-2512
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-7049
  • Fax: 314-344-7073
Mailing address:
  • Phone: 314-344-7049
  • Fax: 314-344-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN R SCHNEIDER
Title or Position: PRESIDENT
Credential: MD
Phone: 314-344-7049