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NPI Code Detail

MEDICARE: WHITE RIVER ANESTHESIA ASSOCIATES, INC

MEDICARE: WHITE RIVER ANESTHESIA ASSOCIATES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist
2207L00000XAnesthesiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3DC8634OTHERMORAILROAD
4194111OTHERMOMISSOURI BCBS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013973296
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHITE RIVER ANESTHESIA ASSOCIATES, INC
Provider Business Mailing Address
First Line : PO BOX 842120
Second Line :
City : KANSAS CITY
State : MO
Zip : 64184-2120
Country : US
Telephone Number : 800-277-8151
Fax Number :
Provider Business Practice Location Address
First Line : 525 BRANSON LANDING BLVD
Second Line :
City : BRANSON
State : MO
Zip : 65616-2052
Country : US
Telephone Number : 417-239-3392
Fax Number : 417-239-3394
Authorized Official
Title or Position : PRESIDENT
Name : JACOB K. LUDER
Credential : M.D.
Telephone Number : 417-239-3392
Provider Enumeration Date : 04/25/2006
Last Update Date : 06/01/2016

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Directions to “WHITE RIVER ANESTHESIA ASSOCIATES, INC ” Practice Location

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