Organization
PACELINE ANESTHESIA SERVICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD C. WORLEY CRNA (PRESIDENT)
(417) 437-2712
Entity
Organization
Contact information
Practice address
5333 S CLOVERDALE LN, BATTLEFIELD, MO 65619-9691
(417) 437-2712
Mailing address
5333 S CLOVERDALE LN, BATTLEFIELD, MO 65619-9691
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
111469
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
509327003
—
MO
Enumeration date
06/02/2006
Last updated
07/21/2011
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