Provider Demographics
NPI:1699875740
Name:ANESTHESIA SERVICES OF EASTERN JACKSON COUNTY, P.C.
Entity type:Organization
Organization Name:ANESTHESIA SERVICES OF EASTERN JACKSON COUNTY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-HR/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:NORM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-389-4138
Mailing Address - Street 1:250 NE MULBERRY ST STE 202
Mailing Address - Street 2:SJS MEDICAL MANAGEMENT
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4533
Mailing Address - Country:US
Mailing Address - Phone:816-389-4138
Mailing Address - Fax:816-389-4140
Practice Address - Street 1:250 NE MULBERRY ST STE 202
Practice Address - Street 2:SJS MEDICAL MANAGEMENT
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4533
Practice Address - Country:US
Practice Address - Phone:816-389-4138
Practice Address - Fax:816-389-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOJ110000Medicare PIN
MOCI4566Medicare UPIN