Provider Demographics
NPI:1316011315
Name:MIDWEST ANESTHESIA P.C.
Entity Type:Organization
Organization Name:MIDWEST ANESTHESIA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOUBRATA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAIKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-721-8895
Mailing Address - Street 1:2900 ELK LN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-8691
Mailing Address - Country:US
Mailing Address - Phone:402-721-8895
Mailing Address - Fax:402-721-6663
Practice Address - Street 1:2900 ELK LN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025
Practice Address - Country:US
Practice Address - Phone:402-721-8895
Practice Address - Fax:402-721-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21157207L00000X, 208VP0014X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty