Healthcare Provider Details

I. General information

NPI: 1558425710
Provider Name (Legal Business Name): ROSS DIMIL ANDREASSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 INDEPENDENCE SQ
WEST PLAINS MO
65775-4239
US

IV. Provider business mailing address

3000 INDEPENDENCE SQ
WEST PLAINS MO
65775-4239
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-1761
  • Fax: 417-256-1763
Mailing address:
  • Phone: 417-256-1761
  • Fax: 417-256-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2000174760
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2000174760
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: