Basic Information
| Provider Information | |||||||||
| NPI: | 1144626581 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDICAL ANESTHESIA ASSOCIATES PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTH OMAHA PAIN MANAGEMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1988 | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515021988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123225565 | ||||||||
| FaxNumber: | 7123225566 | ||||||||
| Practice Location | |||||||||
| Address1: | 3213 S 24TH ST | ||||||||
| Address2: | SUITE 101B | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681081832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025027045 | ||||||||
| FaxNumber: | 7123225566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2014 | ||||||||
| LastUpdateDate: | 11/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7123225565 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.