Basic Information
| Provider Information | |||||||||
| NPI: | 1972674604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED ANESTHESIOLOGISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6911 VAN DORN | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685066825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024894186 | ||||||||
| FaxNumber: | 4024895279 | ||||||||
| Practice Location | |||||||||
| Address1: | 6911 VAN DORN | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685066825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024894186 | ||||||||
| FaxNumber: | 4024895279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 11/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | TINKHAM | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4024894186 | ||||||||
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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 | CE8949 | 01 | NE | RAILROAD MEDICARE | OTHER |