=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669498085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIRKSVILLE ANESTHESIA ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2006
-----------------------------------------------------
Last Update Date | 08/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 W JEFFERSON ST NORTHEAST REGIONAL MEDICAL CENTER
-----------------------------------------------------
City | KIRKSVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63501-1443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-785-1000
-----------------------------------------------------
Fax | 660-785-1237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 702
-----------------------------------------------------
City | KIRKSVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63501-0702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-785-1000
-----------------------------------------------------
Fax | 660-785-1237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MELVIN C. ROOF
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 660-785-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------