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General NPI Number Information
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NPI Number | 1639168206
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Entity Type | Organization
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Legal Business Name | SURGICAL ANESTHESIA OF NORFOLK LLC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 3400 W NORFOLK AVE
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City | NORFOLK
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State | NE
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Zip | 68701-7701
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Country | US
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Telephone | 308-382-7744
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Fax | 308-382-7744
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Provider Business Mailing Address
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Address Line | PO BOX 1611 SURGICAL ANESTHESIA OF NORFOLK LLC
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City | NORFOLK
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State | NE
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Zip | 68702-1611
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Country | US
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Telephone | 308-382-7744
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Fax | 308-382-7744
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTY L RIVERA
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Credential |
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Telephone | 308-382-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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