Healthcare Provider Details

I. General information

NPI: 1609928233
Provider Name (Legal Business Name): ANESTHESIA WEST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7822 DAVENPORT ST
OMAHA NE
68114-3629
US

IV. Provider business mailing address

7822 DAVENPORT ST
OMAHA NE
68114-3629
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-4855
  • Fax: 402-391-4855
Mailing address:
  • Phone: 402-391-4855
  • Fax: 402-391-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: CHAD C BAUERLY
Title or Position: PRESIDENT
Credential: MD
Phone: 402-391-4855