Provider Demographics
NPI:1215043914
Name:STAR ANESTHESIA, PC
Entity type:Organization
Organization Name:STAR ANESTHESIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-423-7774
Mailing Address - Street 1:PO BOX 67099
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7099
Mailing Address - Country:US
Mailing Address - Phone:402-423-7774
Mailing Address - Fax:402-423-7774
Practice Address - Street 1:1730 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1613
Practice Address - Country:US
Practice Address - Phone:402-423-7774
Practice Address - Fax:402-423-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025092100Medicaid
NE10025092100Medicaid