Provider Demographics
NPI:1609155274
Name:MEDICAL ANESTHESIA ASSOCIATES PC
Entity Type:Organization
Organization Name:MEDICAL ANESTHESIA ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-322-5565
Mailing Address - Street 1:25 MAIN PL
Mailing Address - Street 2:SUITE 425
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0792
Mailing Address - Country:US
Mailing Address - Phone:712-322-5565
Mailing Address - Fax:712-322-5566
Practice Address - Street 1:2500 BELLEVUE MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1591
Practice Address - Country:US
Practice Address - Phone:712-322-5565
Practice Address - Fax:712-322-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty