Healthcare Provider Details

I. General information

NPI: 1588032742
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF JOPLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 E 32ND ST SUITE 6
JOPLIN MO
64804-2911
US

IV. Provider business mailing address

1A BURTON HILLS BLVD ATTN:
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 417-627-9699
  • Fax:
Mailing address:
  • Phone: 615-240-3809
  • Fax: 615-234-1809

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: PHILLIP A. CLENDENIN
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283