Provider Demographics
NPI:1659940781
Name:ETH ANESTHESIA, LLC
Entity Type:Organization
Organization Name:ETH ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:HUTTEGER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:402-312-4849
Mailing Address - Street 1:4968 S 176TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3437
Mailing Address - Country:US
Mailing Address - Phone:402-312-4849
Mailing Address - Fax:
Practice Address - Street 1:4968 S 176TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3437
Practice Address - Country:US
Practice Address - Phone:402-312-4849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty