Basic Information
| Provider Information | |||||||||
| NPI: | 1497854574 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIA CONSULTANTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 683 | ||||||||
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| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511020683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122793500 | ||||||||
| FaxNumber: | 8476152858 | ||||||||
| Practice Location | |||||||||
| Address1: | 2720 STONE PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122793500 | ||||||||
| FaxNumber: | 8476152858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 12/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | HAYS | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8476152200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0145581 | 05 | IA | MEDICAID | 0123695 | 05 | IA | MEDICAID | 26667 | 01 | IA | WELLMARK BCBS CRNA GROUP | OTHER | 14558 | 01 | IA | WELLMARK BCBS MD GROUP | OTHER |