Healthcare Provider Details

I. General information

NPI: 1477611937
Provider Name (Legal Business Name): SILVER STATE ANESTHESIA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 GOLF COURSE RD
ELKO NV
89801
US

IV. Provider business mailing address

PO BOX 1529
ELKO NV
89803-1529
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-4700
  • Fax: 775-753-4703
Mailing address:
  • Phone: 775-738-2220
  • Fax: 775-738-3751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD CHARLES KIDWELL
Title or Position: PRESIDENT SILVER STATE ANESTHESIA L
Credential: CRNA
Phone: 775-738-2220