Healthcare Provider Details

I. General information

NPI: 1366774416
Provider Name (Legal Business Name): EMERGENCY PHYSICIANS OF EASTERN NEBRASKA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2010
Last Update Date: 01/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BELLEVUE CENTER DRIVE EMERGENCY DEPARTMENT
BELLEVUE NE
68132
US

IV. Provider business mailing address

4239 FARNAM ST SUITE 326
OMAHA NE
68131-2868
US

V. Phone/Fax

Practice location:
  • Phone: 402-763-3644
  • Fax:
Mailing address:
  • Phone: 402-552-3377
  • Fax: 402-552-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21078
License Number StateNE

VIII. Authorized Official

Name: THOMAS CHEATLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-616-1083