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General NPI Number Information
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NPI Number | 1285237750
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE ANESTHESIA PC
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 1730 S 70TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-1613
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Country | US
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Telephone | 402-423-7774
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Fax | 402-261-5185
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Provider Business Mailing Address
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Address Line | PO BOX 67099
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City | LINCOLN
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State | NE
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Zip | 68506-7099
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Country | US
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Telephone | 402-423-7774
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Fax | 402-261-5185
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | RICKY GENE HARTWIG
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Credential | MD
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Telephone | 402-423-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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