| NPI | 1720458813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID RUSSELL HORACE Administrator 618-235-2299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2015-10-01 |