Provider Demographics
NPI:1629182936
Name:DOCTORS ANESTHESIA GROUP, P.C.
Entity Type:Organization
Organization Name:DOCTORS ANESTHESIA GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-236-5506
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-0963
Mailing Address - Country:US
Mailing Address - Phone:308-236-5506
Mailing Address - Fax:308-236-7089
Practice Address - Street 1:115 E 52ND ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-0502
Practice Address - Country:US
Practice Address - Phone:308-236-5506
Practice Address - Fax:308-236-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NECS2215OtherRAILROAD MEDICARE
NE=========13Medicaid
NE=========13Medicaid