Healthcare Provider Details

I. General information

NPI: 1225073828
Provider Name (Legal Business Name): PREMIER ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 OFFICE PKWY STE 100
SAINT LOUIS MO
63141-7105
US

IV. Provider business mailing address

760 OFFICE PKWY STE 100
SAINT LOUIS MO
63141-7105
US

V. Phone/Fax

Practice location:
  • Phone: 314-200-1462
  • Fax: 314-942-1613
Mailing address:
  • Phone: 314-200-1462
  • Fax: 314-942-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateMO

VIII. Authorized Official

Name: VAFA FOROUGHI
Title or Position: PRESIDENT
Credential: MD
Phone: 314-200-1462