MEDICARE: ANESTHESIA SERVICES LLC

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
1	207LP3000X	Pediatric Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	739014	OTHER	MO	HEALTHLINK PROVDER #
2	203824	OTHER	MO	BLUE CROSS PROVIDER
3	275057	OTHER	MO	GROUP HEALTH PLAN #

General Provider Information

NPI Number	:	1326249475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA SERVICES LLC

Provider Business Mailing Address
First Line	:	11600 MANCHESTER RD STE 101
Second Line	:
City	:	DES PERES
State	:	MO
Zip	:	63131-4691
Country	:	US
Telephone Number	:	314-446-0050
Fax Number	:	314-822-8476

Provider Business Practice Location Address
First Line	:	11600 MANCHESTER RD STE 101
Second Line	:
City	:	DES PERES
State	:	MO
Zip	:	63131-4691
Country	:	US
Telephone Number	:	314-446-0050
Fax Number	:	314-822-8476

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SUE EKSTROM
Credential	:
Telephone Number	:	314-446-0050

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	08/22/2020

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Directions to “ANESTHESIA SERVICES LLC ” Practice Location

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