Basic Information
| Provider Information | |||||||||
| NPI: | 1982648515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIBERAL ANESTHESIA CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 739 | ||||||||
| Address2: | |||||||||
| City: | LIBERAL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 679050739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206241550 | ||||||||
| FaxNumber: | 6206242545 | ||||||||
| Practice Location | |||||||||
| Address1: | 15TH AT PERSHING | ||||||||
| Address2: | |||||||||
| City: | LIBERAL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 679012455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206241651 | ||||||||
| FaxNumber: | 6206296655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | POHORECKI | ||||||||
| AuthorizedOfficialFirstName: | ROMAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6206241550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | 110697 | 01 | KS | BLUE CROSS GROUP NUMBER | OTHER | CJ4055 | 01 | KS | RAILROAD MEDICARE GROUP | OTHER |