MEDICARE: MR. ANTHONY CLEMONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1396544466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY CLEMONS

Provider Business Mailing Address
First Line	:	4611 S 96TH ST STE 150
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1240
Country	:	US
Telephone Number	:	402-613-7198
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 PEREGRINE RD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-2693
Country	:	US
Telephone Number	:	816-299-6088
Fax Number	:	816-299-6088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	03/11/2025

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Directions to “ MR. ANTHONY CLEMONS ” Practice Location

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