Healthcare Provider Details

I. General information

NPI: 1659384188
Provider Name (Legal Business Name): ST JOSEPH ANESTHESIA SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CARONDELET DR
KANSAS CITY MO
64114-4673
US

IV. Provider business mailing address

10310 STATE LINE RD STE A
LEAWOOD KS
66206-2695
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-2252
  • Fax: 816-943-4656
Mailing address:
  • Phone: 913-647-4101
  • Fax: 913-647-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT G JOHNSON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 816-943-2252