Organization
FOUR RIVERS ANESTHESIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER G WIENKE MD (PRESIDENT)
(636) 239-1766
Entity
Organization
Contact information
Practice address
1111 E 6TH ST, WASHINGTON, MO 63090-3308
(636) 239-1766
Mailing address
1 EAST LN, UNION, MO 63084-1772
(636) 239-1766
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R8N11
MO
Other
Enumeration date
10/28/2009
Last updated
10/28/2009
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