Healthcare Provider Details

I. General information

NPI: 1215975156
Provider Name (Legal Business Name): COMPREHENSIVE ANESTHESIA CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD ANESTHESIA DEPARTMENT
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

232 S WOODS MILL RD ANESTHESIA DEPARTMENT
CHESTERFIELD MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6917
  • Fax: 314-205-6832
Mailing address:
  • Phone: 314-205-6917
  • Fax: 314-205-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateMO

VIII. Authorized Official

Name: DR. GEORGE H NIESEN
Title or Position: PRESIDENT
Credential: MD
Phone: 314-205-6917