Basic Information
| Provider Information | |||||||||
| NPI: | 1629182936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS ANESTHESIA GROUP, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 963 | ||||||||
| Address2: | |||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688480963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082365506 | ||||||||
| FaxNumber: | 3082367089 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 E 52ND ST | ||||||||
| Address2: | |||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688470502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082365506 | ||||||||
| FaxNumber: | 3082367089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 03/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3082365506 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | CS2215 | 01 | NE | RAILROAD MEDICARE | OTHER |