Provider Demographics
NPI:1962809244
Name:VIKING ANESTHESIA SERVICES, LLC
Entity type:Organization
Organization Name:VIKING ANESTHESIA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-692-8411
Mailing Address - Street 1:425 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6814
Mailing Address - Country:US
Mailing Address - Phone:314-692-8411
Mailing Address - Fax:
Practice Address - Street 1:425 N NEW BALLAS RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6814
Practice Address - Country:US
Practice Address - Phone:314-692-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104661207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty