Basic Information
| Provider Information | |||||||||
| NPI: | 1205163623 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NPPI - ANESTHESIOLOGY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHILDREN'S SPECIALTY PHYSICIANS-ANESTHESIOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30265 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681031365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004117538 | ||||||||
| FaxNumber: | 8173340235 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 DODGE STREET | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681144113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029554303 | ||||||||
| FaxNumber: | 4029554300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2009 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | WEILER | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 4029556826 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NPPI - ANESTHESIOLOGY | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP3000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 367500000X | NE | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207LP3000X | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
No ID Information.