Provider Demographics
NPI:1043511447
Name:TB ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:TB ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-686-5550
Mailing Address - Street 1:30 HOLMAN RD
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3202
Mailing Address - Country:US
Mailing Address - Phone:573-686-5550
Mailing Address - Fax:573-686-2139
Practice Address - Street 1:2103 SILVA LN
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3660
Practice Address - Country:US
Practice Address - Phone:660-263-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1043511447OtherBCBS
MO1043511447Medicaid
MO1043511447Medicaid