Healthcare Provider Details

I. General information

NPI: 1720040165
Provider Name (Legal Business Name): MISSOURI VALLEY ANESTHESIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 5TH ST
WASHINGTON MO
63090-3127
US

IV. Provider business mailing address

601 WASHINGTON AVE
NEWPORT KY
41071-1986
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8090
  • Fax: 636-390-7385
Mailing address:
  • Phone: 859-291-4800
  • Fax: 859-655-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT NEVETT
Title or Position: PRESIDENT
Credential: MD
Phone: 636-239-8090