Organization
PRO ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH CHI-KONG MOY DO (OWNER)
(800) 277-8151
Entity
Organization
Contact information
Practice address
1008 N MAIN ST, SIKESTON, MO 63801-5044
(888) 447-7220
(336) 884-1643
Mailing address
PO BOX 220, SIKESTON, MO 63801-0220
(888) 447-7220
(336) 884-1643
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125876
BLUE CROSS
MO
Enumeration date
11/15/2006
Last updated
06/21/2010
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