Healthcare Provider Details

I. General information

NPI: 1245880376
Provider Name (Legal Business Name): ZIM ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11606 NICHOLAS ST
OMAHA NE
68154-4478
US

IV. Provider business mailing address

2615 N 188TH ST
ELKHORN NE
68022-4540
US

V. Phone/Fax

Practice location:
  • Phone: 402-493-2020
  • Fax:
Mailing address:
  • Phone: 402-968-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MVIKELI NDEBELE
Title or Position: CRNA
Credential:
Phone: 402-968-2455