MEDICARE: NEBRASKA SURGICAL ANESTHESIA SERVICES 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	174400000X	Specialist

General Provider Information

NPI Number	:	1588913180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEBRASKA SURGICAL ANESTHESIA SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 935566
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-5566
Country	:	US
Telephone Number	:	636-938-6868
Fax Number	:

Provider Business Practice Location Address
First Line	:	11819 MIRACLE HILLS DRIVE
Second Line	:	SUITE 201
City	:	OMAHA
State	:	NE
Zip	:	68154-5308
Country	:	US
Telephone Number	:	800-835-9102
Fax Number	:	706-650-1034

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANDREW R. RIBAUDO
Credential	:
Telephone Number	:	404-446-1417

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	04/05/2016

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