=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750343331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREAT PLAINS ANESTHESIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 05/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4601 50TH ST SUITE 112
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79414-3513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-785-8000
-----------------------------------------------------
Fax | 806-792-7174
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 93882
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79493-3882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-785-8000
-----------------------------------------------------
Fax | 806-792-7174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RAYMOND MICHAEL DANCHAK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 806-785-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------