Healthcare Provider Details

I. General information

NPI: 1396209987
Provider Name (Legal Business Name): EDWARD D STEIL JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E BROADWAY
COLUMBIA MO
65201-5844
US

IV. Provider business mailing address

1316 OLD HIGHWAY 63 S
COLUMBIA MO
65201-6092
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8000
  • Fax:
Mailing address:
  • Phone: 573-875-8838
  • Fax: 573-875-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2019001534
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: