Provider Demographics
NPI:1639227150
Name:STEPHEN P ADLEY ANESTHESIA PC
Entity Type:Organization
Organization Name:STEPHEN P ADLEY ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-391-3333
Mailing Address - Street 1:8051 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3151
Mailing Address - Country:US
Mailing Address - Phone:402-391-3333
Mailing Address - Fax:402-391-8593
Practice Address - Street 1:8051 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3151
Practice Address - Country:US
Practice Address - Phone:402-391-3333
Practice Address - Fax:402-391-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11235207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061760713Medicaid
NE47061760713Medicaid
NE098912Medicare PIN