Healthcare Provider Details

I. General information

NPI: 1689947202
Provider Name (Legal Business Name): SOUTH COUNTY ANESTHESIA ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 BOWLES AVE SUITE 200
FENTON MO
63026-2308
US

IV. Provider business mailing address

PO BOX 22407
SAINT LOUIS MO
63126-0407
US

V. Phone/Fax

Practice location:
  • Phone: 636-496-3900
  • Fax: 636-386-1170
Mailing address:
  • Phone: 636-386-7222
  • Fax: 636-386-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA L RAU
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-386-7222