MEDICARE: SURGICAL ANESTHESIA SERVICES OF CALIFORNIA

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	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1588831531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL ANESTHESIA SERVICES OF CALIFORNIA

Provider Business Mailing Address
First Line	:	13523 BARRETT PARKWAY DRIVE
Second Line	:	SUITE 104
City	:	BALLWIN
State	:	MO
Zip	:	63021-3802
Country	:	US
Telephone Number	:	636-549-2404
Fax Number	:	636-549-2392

Provider Business Practice Location Address
First Line	:	2120 COWELL BLVD.
Second Line	:	SUITE 142
City	:	DAVIS
State	:	CA
Zip	:	95618-7840
Country	:	US
Telephone Number	:	530-750-7755
Fax Number	:	530-750-7767

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW R RIBAUDO
Credential	:
Telephone Number	:	404-217-2659

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	04/11/2013

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Directions to “SURGICAL ANESTHESIA SERVICES OF CALIFORNIA ” Practice Location

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