Healthcare Provider Details

I. General information

NPI: 1588476451
Provider Name (Legal Business Name): RICHARD SAMUEL WARGOWSKY CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

1552 MOORINGS DR APT 11B
RESTON VA
20190
US

V. Phone/Fax

Practice location:
  • Phone: 417-841-5101
  • Fax: 417-820-3107
Mailing address:
  • Phone: 703-282-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number2026031366
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: