Healthcare Provider Details

I. General information

NPI: 1649285032
Provider Name (Legal Business Name): ANESTHESIA AFFILIATES GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 S 84TH ST ANETHESIA DEPT
PAPILLION NE
68131
US

IV. Provider business mailing address

PO BOX 31733
OMAHA NE
68131
US

V. Phone/Fax

Practice location:
  • Phone: 402-593-3830
  • Fax:
Mailing address:
  • Phone: 314-453-0600
  • Fax: 314-453-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID LOJERO
Title or Position: PRESIDENT
Credential: MD
Phone: 402-593-3830