MEDICARE: GREATER OMAHA ANESTHESIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1356076558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER OMAHA ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	10782 V ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-2952
Country	:	US
Telephone Number	:	402-504-9747
Fax Number	:	402-991-6766

Provider Business Practice Location Address
First Line	:	10782 V ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-2952
Country	:	US
Telephone Number	:	402-504-9747
Fax Number	:	402-991-6766

Authorized Official
Title or Position	:	MANAGER
Name	:	TINA ARNDT
Credential	:
Telephone Number	:	402-504-9747

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	09/26/2022

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Directions to “GREATER OMAHA ANESTHESIA LLC ” Practice Location

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