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General NPI Number Information
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NPI Number | 1013973296
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Entity Type | Organization
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Legal Business Name | WHITE RIVER ANESTHESIA ASSOCIATES, INC
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 525 BRANSON LANDING BLVD
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City | BRANSON
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State | MO
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Zip | 65616-2052
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Country | US
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Telephone | 417-239-3392
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Fax | 417-239-3394
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Provider Business Mailing Address
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Address Line | PO BOX 842120
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City | KANSAS CITY
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State | MO
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Zip | 64184-2120
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Country | US
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Telephone | 800-277-8151
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACOB K. LUDER
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Credential | M.D.
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Telephone | 417-239-3392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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