Organization
MOBERLY ANESTHESIA ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY WILSON CRNA (OWNER)
(660) 676-5960
Entity
Organization
Contact information
Practice address
1515 UNION AVE, MOBERLY, MO 65270-9407
(660) 263-8400
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125164
BCBS
MO
05
—
504860800
—
MO
01
—
CG5447
RAILROAD MEDICARE
MO
Enumeration date
02/02/2006
Last updated
05/04/2023
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