Provider Demographics
NPI:1710500541
Name:MID PLAINS ANESTHESIA, LLC
Entity Type:Organization
Organization Name:MID PLAINS ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:605-212-8674
Mailing Address - Street 1:2200 S OAK CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-6311
Mailing Address - Country:US
Mailing Address - Phone:605-212-8674
Mailing Address - Fax:
Practice Address - Street 1:2900 ELK LN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-8691
Practice Address - Country:US
Practice Address - Phone:402-721-8895
Practice Address - Fax:402-721-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty