Provider Demographics
NPI:1063635621
Name:SIMS, SAMUEL R (CRNA)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:SIMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-3027
Mailing Address - Country:US
Mailing Address - Phone:712-790-2949
Mailing Address - Fax:
Practice Address - Street 1:600 W 12TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-3130
Practice Address - Country:US
Practice Address - Phone:308-882-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119772163W00000X
SCR 100585163WC0200X
IAD-119772367500000X
NE101237367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine