Provider Demographics
NPI:1639168206
Name:SURGICAL ANESTHESIA OF NORFOLK LLC
Entity Type:Organization
Organization Name:SURGICAL ANESTHESIA OF NORFOLK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-382-7744
Mailing Address - Street 1:PO BOX 1611
Mailing Address - Street 2:SURGICAL ANESTHESIA OF NORFOLK LLC
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-1611
Mailing Address - Country:US
Mailing Address - Phone:308-382-7744
Mailing Address - Fax:308-382-7744
Practice Address - Street 1:3400 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-7701
Practice Address - Country:US
Practice Address - Phone:308-382-7744
Practice Address - Fax:308-382-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025009800Medicaid
NE10024970800Medicaid
NE10024970800Medicaid