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General NPI Number Information
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NPI Number | 1609155274
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Entity Type | Organization
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Legal Business Name | MEDICAL ANESTHESIA ASSOCIATES PC
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 2500 BELLEVUE MEDICAL CENTER DR
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City | BELLEVUE
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State | NE
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Zip | 68123-1591
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Country | US
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Telephone | 712-322-5565
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Fax | 712-322-5566
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Provider Business Mailing Address
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Address Line | 25 MAIN PL SUITE 425
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0792
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Country | US
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Telephone | 712-322-5565
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Fax | 712-322-5566
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAM SMITH
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Credential |
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Telephone | 712-322-5565
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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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