Organization
RIVERSIDE ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRED ANDERSON CRNA (OWNER)
(573) 785-4601
Entity
Organization
Contact information
Practice address
2106 LOOP RD, WINNSBORO, LA 71295-3344
(318) 435-9411
Mailing address
PO BOX 550, POPLAR BLUFF, MO 63902-0550
(573) 785-4601
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04321278
—
MS
05
—
1447561
—
KY
Enumeration date
05/15/2006
Last updated
06/23/2026
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