Provider Demographics
NPI:1477611937
Name:SILVER STATE ANESTHESIA LTD
Entity Type:Organization
Organization Name:SILVER STATE ANESTHESIA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SILVER STATE ANESTHESIA L
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:775-738-2220
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-1529
Mailing Address - Country:US
Mailing Address - Phone:775-738-2220
Mailing Address - Fax:775-738-3751
Practice Address - Street 1:855 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-753-4700
Practice Address - Fax:775-753-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV38296Medicare ID - Type Unspecified