# ROBERT H AND TERESITA S PETTY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CROSSROADS ANESTHESIA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306913868
- **Authorized official:** ROBERT H PETTY MD (PRESIDENT)
- **Authorized official phone:** (217) 342-1234

## Contact information

- **Practice address:** 904 W TEMPLE AVE, EFFINGHAM, IL 62401-2178
- **Practice address phone:** (217) 342-1234
- **Practice address fax:** (816) 461-6586
- **Mailing address:** PO BOX 1660, INDEPENDENCE, MO 64055-0660
- **Mailing address phone:** (816) 461-8288
- **Mailing address fax:** (816) 461-6586

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 02/11/2008