Healthcare Provider Details

I. General information

NPI: 1487807012
Provider Name (Legal Business Name): WARRENSBURG ANESTHESIA & PAIN TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BURKARTH RD
WARRENSBURG MO
64093-3101
US

IV. Provider business mailing address

PO BOX 952248
DALLAS TX
75395-0001
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-2500
  • Fax:
Mailing address:
  • Phone: 201-804-2800
  • Fax: 201-804-8883

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. STEVEN GOTTLIEB
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 561-799-3552