Provider Demographics
NPI:1750343331
Name:GREAT PLAINS ANESTHESIA
Entity type:Organization
Organization Name:GREAT PLAINS ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DANCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-785-8000
Mailing Address - Street 1:PO BOX 93882
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-3882
Mailing Address - Country:US
Mailing Address - Phone:806-785-8000
Mailing Address - Fax:806-792-7174
Practice Address - Street 1:4601 50TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3513
Practice Address - Country:US
Practice Address - Phone:806-785-8000
Practice Address - Fax:806-792-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082441901Medicaid
TX00F26YMedicare ID - Type Unspecified