Provider Demographics
NPI:1063529014
Name:MEDICAL ANESTHESIA ASSOCIATES PC
Entity type:Organization
Organization Name:MEDICAL ANESTHESIA ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:402-212-9418
Mailing Address - Street 1:201 RIDGE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4643
Mailing Address - Country:US
Mailing Address - Phone:712-396-4359
Mailing Address - Fax:712-396-7888
Practice Address - Street 1:201 RIDGE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-322-5565
Practice Address - Fax:712-322-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0067520Medicaid
IA58228Medicare PIN
IA06752Medicare PIN
IA26664Medicare PIN
IA0067520Medicaid
IA0067520Medicaid