Healthcare Provider Details

I. General information

NPI: 1275646754
Provider Name (Legal Business Name): WESTERN ANESTHESIOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD DEPT. OF ANESTHESIA
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

339 CONSORT DR
BALLWIN MO
63011-4439
US

V. Phone/Fax

Practice location:
  • Phone: 636-386-9224
  • Fax: 636-386-7679
Mailing address:
  • Phone: 636-386-9224
  • Fax: 636-386-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE JOHANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 636-386-9224