Organization
SHADOW ANESTHESIA SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HOLLY VICTORIA LASHMET CRNA (CHIEF)
(605) 845-3502
Entity
Organization
Contact information
Practice address
1401 10TH AVE W, MOBRIDGE, SD 57601
(605) 845-8271
(605) 845-3502
Mailing address
403 10TH ST E, MOBRIDGE, SD 57601-1813
(402) 802-0246
(605) 845-3502
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
100997
NE
282N00000X
General Acute Care Hospital
100997
NE
282NC0060X
Critical Access Hospital
100997
NE
282NC0060X
Critical Access Hospital
55417
KS
282NR1301X
Rural Acute Care Hospital
Primary
CR000953
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11654543
CAQH
KS
05
—
145111
—
SD
05
—
200304330
—
KS
Enumeration date
07/27/2010
Last updated
07/16/2018
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