Provider Demographics
NPI:1902992175
Name:ADVANCED ANESTHESIA LLC
Entity Type:Organization
Organization Name:ADVANCED ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:WEYGANDT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:636-326-4716
Mailing Address - Street 1:333 HAYS HILL DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3159
Mailing Address - Country:US
Mailing Address - Phone:636-326-4716
Mailing Address - Fax:
Practice Address - Street 1:1101 WEST GANNON ROAD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-931-5997
Practice Address - Fax:636-937-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty