Healthcare Provider Details

I. General information

NPI: 1356858419
Provider Name (Legal Business Name): CHI HEALTH CLINIC PHYSICIAN ENTERPRISE-ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MERCY RD STE 1355
OMAHA NE
68124-2319
US

IV. Provider business mailing address

7261 MERCY RD ATTN LISA SMITH
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-4866
  • Fax: 402-717-6068
Mailing address:
  • Phone: 402-398-6255
  • Fax: 402-829-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DAVID PRITZA
Title or Position: SYSTEM SVP
Credential: MD
Phone: 402-343-4477