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General NPI Number Information
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NPI Number | 1225073828
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Entity Type | Organization
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Legal Business Name | PREMIER ANESTHESIA LLC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 760 OFFICE PKWY STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7105
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Country | US
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Telephone | 314-200-1462
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Fax | 314-942-1613
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Provider Business Mailing Address
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Address Line | 760 OFFICE PKWY STE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7105
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Country | US
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Telephone | 314-200-1462
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Fax | 314-942-1613
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Authorized Official
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Title or Position | PRESIDENT
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Name | VAFA FOROUGHI
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Credential | MD
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Telephone | 314-200-1462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | MO
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Taxonomy #2
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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 | MO
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Taxonomy #3
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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 | MO
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