Provider Demographics
NPI:1487899472
Name:WESTERN ANESTHESIOLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:WESTERN ANESTHESIOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-386-9224
Mailing Address - Street 1:5401 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1680
Mailing Address - Country:US
Mailing Address - Phone:636-442-5070
Mailing Address - Fax:636-442-5071
Practice Address - Street 1:5401 VETERANS MEMORIAL PKWY
Practice Address - Street 2:SUITE #102
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1680
Practice Address - Country:US
Practice Address - Phone:636-442-5070
Practice Address - Fax:636-442-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty