Provider Demographics
NPI:1992127609
Name:ANESTHESIA SERVICES OF OMAHA LLC
Entity type:Organization
Organization Name:ANESTHESIA SERVICES OF OMAHA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DABBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-693-1000
Mailing Address - Street 1:7500 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2319
Mailing Address - Country:US
Mailing Address - Phone:402-398-6060
Mailing Address - Fax:
Practice Address - Street 1:265 BROOKVIEW CENTRE WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4049
Practice Address - Country:US
Practice Address - Phone:888-203-1274
Practice Address - Fax:865-291-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty