Provider Demographics
NPI:1982648515
Name:LIBERAL ANESTHESIA CONSULTANTS LLC
Entity Type:Organization
Organization Name:LIBERAL ANESTHESIA CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POHORECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-624-1550
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-0739
Mailing Address - Country:US
Mailing Address - Phone:620-624-1550
Mailing Address - Fax:620-624-2545
Practice Address - Street 1:15TH AT PERSHING
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-1651
Practice Address - Fax:620-629-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110697OtherBLUE CROSS GROUP NUMBER
KSCJ4055OtherRAILROAD MEDICARE GROUP
KS110697OtherBLUE CROSS GROUP NUMBER