Revere Anesthesiology LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

R6445 Issued in MO

Legal business name

REVERE ANESTHESIOLOGY LLC

Practice address

1101 W Gannon Dr
Festus, MO 63028-2602

Phone

(636) 931-5997

NPI assigned

Jul 15, 2009

Last updated

Jul 15, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Rodolfo L Maceren, MD

Title

President

Phone

(636) 933-6569

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247616000000",
    "number": "1912137712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 HOWE XING",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W GANNON DR",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630282602",
            "telephone_number": "636-931-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERE ANESTHESIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-15",
        "last_updated": "2009-07-15",
        "status": "A",
        "authorized_official_last_name": "MACEREN",
        "authorized_official_first_name": "RODOLFO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "636-933-6569",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "R6445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassidy Reid
• Robin Reifsteck
• Jessica Reiter
• Renal Treatment Centers-Illinois Inc (Crystal City Dialysis Center)
• Cari Rende, FNP
• Revital LLC
• Rheum Care LLC
• Jennifer Richey
• Kristen Rider, APRN, NP-C
• Diana M. Ridgon, LPC

• Anesthesiology Physician in Festus, MO
• Providers in Festus, MO by specialty
• Anesthesiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.