1922208354 NPI number — ANESTHESIA PROFESSIONAL, PC

Table of content: (NPI 1922208354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922208354 NPI number — ANESTHESIA PROFESSIONAL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA PROFESSIONAL, PC
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:
Provider Other Organization Name Type Code:
6
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:
1922208354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45771
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:
68145-0771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-727-9995
Provider Business Mailing Address Fax Number:
402-727-9996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 E 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68025-2657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-727-9995
Provider Business Practice Location Address Fax Number:
402-727-9996
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
402-727-9995

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  16977 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1548307515 . This is a "ANESTHESIA PROFESSIONALS," identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1710921119 . This is a "DR. JEFFREY EDWARDS INDI" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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