1205163623 NPI number — NPPI - ANESTHESIOLOGY

Table of content: (NPI 1205163623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205163623 NPI number — NPPI - ANESTHESIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NPPI - ANESTHESIOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHILDREN'S SPECIALTY PHYSICIANS-ANESTHESIOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205163623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30265
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68103-1365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-411-7538
Provider Business Mailing Address Fax Number:
817-334-0235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 DODGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-955-4303
Provider Business Practice Location Address Fax Number:
402-955-4300
Provider Enumeration Date:
11/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WEILER
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR MANAGED CARE
Authorized Official Telephone Number:
402-955-6826

Provider Taxonomy Codes

  • Taxonomy code: 207LP3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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