Healthcare Provider Details

I. General information

NPI: 1598025504
Provider Name (Legal Business Name): WEST PLAINS ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 DOCTORS DR
WEST PLAINS MO
65775-4754
US

IV. Provider business mailing address

1401 DOCTORS DR
WEST PLAINS MO
65775-4754
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-1400
  • Fax: 417-256-2885
Mailing address:
  • Phone: 417-256-1400
  • Fax: 417-256-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE WORLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-256-1400