Organization
MID-LAND ANESTHESIA ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK ROBERTS CPA (PRESIDENT)
(573) 686-5550
Entity
Organization
Contact information
Practice address
219 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 686-5550
Mailing address
RR 1 BOX 366, WILLIAMSVILLE, MO 63967-9724
(573) 686-5550
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184883
MO BCBS
MO
01
—
DA7268
RAILROAD MEDICARE
MO
Enumeration date
01/12/2006
Last updated
07/21/2022
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