Healthcare Provider Details

I. General information

NPI: 1851010417
Provider Name (Legal Business Name): GI ALLIANCE ANESTHESIA OF MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17501 E US HIGHWAY 40 STE 213A
INDEPENDENCE MO
64055-6445
US

IV. Provider business mailing address

550 RESERVE ST STE 560
SOUTHLAKE TX
76092-1607
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4887
  • Fax:
Mailing address:
  • Phone: 817-402-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRANDI WHEELER
Title or Position: ANESTHESIA SUPPORT SERVICE COORDINA
Credential:
Phone: 817-402-7526