Organization
DEACONESS ANESTHESIA SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CLEMENS MD, PHD (CEO)
(660) 826-5960
Entity
Organization
Contact information
Practice address
5501 N PORTLAND AVE, OKLAHOMA CITY, OK 73112-2074
(660) 826-5960
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200705720A
—
OK
Enumeration date
04/26/2017
Last updated
02/21/2020
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