Basic Information
Provider Information | |||||||||
NPI: | 1457414450 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FREEMAN ANESTHESIA PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 905 W ELKHORN ST | ||||||||
Address2: |   | ||||||||
City: | PIERCE | ||||||||
State: | NE | ||||||||
PostalCode: | 687671126 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6053351952 | ||||||||
FaxNumber: | 6053739971 | ||||||||
Practice Location | |||||||||
Address1: | 3772 43RD AVE STE B | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | NE | ||||||||
PostalCode: | 686011681 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4023294027 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/19/2006 | ||||||||
LastUpdateDate: | 06/25/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FREEMAN | ||||||||
AuthorizedOfficialFirstName: | LISA | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | OWNDER/CRNA | ||||||||
AuthorizedOfficialTelephone: | 6059772767 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | CRNA | ||||||||
NPICertificationDate: | 06/25/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0471 | NE | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | DG0389 | 01 | NE | RAILROAD MEDICARE | OTHER | 10025472700 | 05 | NE |   | MEDICAID |