Organization
WHITE RIVER ANESTHESIA ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB K. LUDER M.D. (PRESIDENT)
(417) 239-3392
Entity
Organization
Contact information
Practice address
525 BRANSON LANDING BLVD, BRANSON, MO 65616-2052
(417) 239-3392
(417) 239-3394
Mailing address
PO BOX 842120, KANSAS CITY, MO 64184-2120
(800) 277-8151
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158909002
—
AR
01
—
194111
MISSOURI BCBS
MO
05
—
200077410A
—
OK
05
—
508765401
—
MO
01
—
DC8634
RAILROAD
MO
Enumeration date
04/25/2006
Last updated
06/01/2016
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