Healthcare Provider Details

I. General information

NPI: 1942596002
Provider Name (Legal Business Name): PHYSICIANS' AMBULATORY ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12266 DEPAUL DRIVE
BRIDGETON MO
63044-2514
US

IV. Provider business mailing address

1860 GATEMONT DR
CHESTERFIELD MO
63017-8012
US

V. Phone/Fax

Practice location:
  • Phone: 314-291-7500
  • Fax: 314-291-7501
Mailing address:
  • Phone: 314-283-8498
  • Fax: 636-220-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAMA MOHMOUD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-283-8498