Healthcare Provider Details

I. General information

NPI: 1982905311
Provider Name (Legal Business Name): TB ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOSPITAL DR
COLUMBIA MO
65201-5275
US

IV. Provider business mailing address

PO BOX 67
MOBERLY MO
65270-0067
US

V. Phone/Fax

Practice location:
  • Phone: 573-814-6000
  • Fax:
Mailing address:
  • Phone: 573-814-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2005006158
License Number StateMO

VIII. Authorized Official

Name: DR. TAMRA SUE BUSICK
Title or Position: OWNER
Credential: D.O.
Phone: 573-814-6000