Healthcare Provider Details

I. General information

NPI: 1689095465
Provider Name (Legal Business Name): OMAHA ANESTHESIA & PAIN TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MERCY RD
OMAHA NE
68124-2319
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY SUITE 400
KNOXVILLE TN
37919-4049
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-6060
  • Fax:
Mailing address:
  • Phone: 888-203-1274
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: RANDAL DABBS
Title or Position: OWNER
Credential: MD
Phone: 888-203-1274