Basic Information
| Provider Information | |||||||||
| NPI: | 1316011315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST ANESTHESIA P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 ELK LN | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680258691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027218895 | ||||||||
| FaxNumber: | 4027216663 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 ELK LN | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027218895 | ||||||||
| FaxNumber: | 4027216663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | RAIKAR | ||||||||
| AuthorizedOfficialFirstName: | SOUBRATA | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4027218895 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 21157 | NE | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | 21157 | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.