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General NPI Number Information
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NPI Number | 1508251083
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Entity Type | Organization
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Legal Business Name | EDDINGTON ANESTHESIA INC
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 1233 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82601-2926
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Country | US
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Telephone | 301-577-7201
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Fax |
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Provider Business Mailing Address
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Address Line | 5323 BUTLER HILL ESTATES DR
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3721
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JORDAN EDDINGTON
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Credential | MD
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Telephone | 314-413-8359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | TL2889
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License Number State | WY
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