Provider Demographics
NPI:1124071329
Name:MARSHALL ANESTHESIOLOGY, LLC
Entity type:Organization
Organization Name:MARSHALL ANESTHESIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:660-831-3213
Mailing Address - Street 1:400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-4552
Mailing Address - Country:US
Mailing Address - Phone:952-442-9770
Mailing Address - Fax:952-442-3630
Practice Address - Street 1:2305 S HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-9889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18935029OtherBLUE CROSS OF KANSAS CITY
MO503928004Medicaid
MO=========OtherTRICARE
MO18935029OtherBLUE CROSS OF KANSAS CITY
MODC8502Medicare ID - Type UnspecifiedRAILROAD MEDICARE