Healthcare Provider Details

I. General information

NPI: 1396116521
Provider Name (Legal Business Name): RESOURCE ANESTHESIOLOGY ASSOCIATES OF MO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 N MAIN ST
SIKESTON MO
63801-5044
US

IV. Provider business mailing address

450 MAMARONECK AVE STE 201
HARRISON NY
10528-2436
US

V. Phone/Fax

Practice location:
  • Phone: 914-637-2063
  • Fax:
Mailing address:
  • Phone: 914-637-2075
  • Fax: 914-365-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARC KOCH
Title or Position: PRESIDENT
Credential: MD
Phone: 914-637-3563