Healthcare Provider Details

I. General information

NPI: 1306108246
Provider Name (Legal Business Name): LOHMAN ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

209 S MAIN ST
POPLAR BLUFF MO
63901-5831
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-5550
  • Fax:
Mailing address:
  • Phone: 573-686-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. THOMAS V NATTAKOM
Title or Position: PRESIDENT
Credential: MD
Phone: 573-686-5550