Healthcare Provider Details

I. General information

NPI: 1841609294
Provider Name (Legal Business Name): QUEEN CITY ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

5665 NEW NORTHSIDE DR SUITE 320
ATLANTA GA
30328-5831
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-6000
  • Fax: 770-874-5483
Mailing address:
  • Phone: 770-874-5400
  • Fax: 770-874-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROGER P MURRAY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 770-874-5400