Healthcare Provider Details

I. General information

NPI: 1326091059
Provider Name (Legal Business Name): MID-MISSOURI ANESTHESIA CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 MISSION DR
JEFFERSON CITY MO
65109-9508
US

IV. Provider business mailing address

3218 EMERALD LN STE C
JEFFERSON CITY MO
65109-6948
US

V. Phone/Fax

Practice location:
  • Phone: 573-636-3483
  • Fax: 573-636-3386
Mailing address:
  • Phone: 573-636-3483
  • Fax: 573-636-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JODIE EARNEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-636-3483