Healthcare Provider Details

I. General information

NPI: 1043299910
Provider Name (Legal Business Name): AMBULATORY ANESTHESIA SERVICES OF SPRINGFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 S NATIONAL AVE SUITE 101
SPRINGFIELD MO
65804-4247
US

IV. Provider business mailing address

3045 S NATIONAL AVE SUITE 100
SPRINGFIELD MO
65804-4247
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-1900
  • Fax: 417-882-1966
Mailing address:
  • Phone: 417-882-1900
  • Fax: 417-882-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number058813
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number063768
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR9D64
License Number StateMO

VIII. Authorized Official

Name: REBECCA J PRICE
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 417-882-1900