Provider Demographics
NPI:1215975156
Name:COMPREHENSIVE ANESTHESIA CARE PC
Entity type:Organization
Organization Name:COMPREHENSIVE ANESTHESIA CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:NIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-205-6917
Mailing Address - Street 1:232 S WOODS MILL RD
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-205-6917
Mailing Address - Fax:314-205-6832
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-205-6917
Practice Address - Fax:314-205-6832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 207LP2900X
MO367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000060242Medicare PIN
MO000012447Medicare PIN