Provider Demographics
NPI:1548307515
Name:ANESTHESIA PROFESSIONALS, P.C.
Entity type:Organization
Organization Name:ANESTHESIA PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-894-9990
Mailing Address - Street 1:P.O. BOX 45771
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68145-0771
Mailing Address - Country:US
Mailing Address - Phone:402-894-9990
Mailing Address - Fax:402-884-0129
Practice Address - Street 1:10020 NICHOLAS ST
Practice Address - Street 2:STE 106
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2189
Practice Address - Country:US
Practice Address - Phone:402-894-9990
Practice Address - Fax:402-884-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16977174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE086993Medicare ID - Type Unspecified
NE=========13Medicaid