Healthcare Provider Details

I. General information

NPI: 1578649216
Provider Name (Legal Business Name): MIDWEST ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NEW BALLAS RD SUITE #103
SAINT LOUIS MO
63141-6835
US

IV. Provider business mailing address

450 N NEW BALLAS RD SUITE #103
SAINT LOUIS MO
63141-6835
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-0776
  • Fax: 314-991-4763
Mailing address:
  • Phone: 314-991-0776
  • Fax: 314-991-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHEN BELL
Title or Position: DIRECTOR/ADMINISTRATOR
Credential: MD
Phone: 314-991-0776