Healthcare Provider Details

I. General information

NPI: 1093877920
Provider Name (Legal Business Name): MOMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 NORTH 66TH ST SUITE 8
LINCOLN NE
68505
US

IV. Provider business mailing address

415 NORTH 66TH ST SUITE 8
LINCOLN NE
68505
US

V. Phone/Fax

Practice location:
  • Phone: 402-464-6667
  • Fax: 402-464-6669
Mailing address:
  • Phone: 402-464-6667
  • Fax: 402-464-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOAN S PHILLIPS
Title or Position: VICE PRESIDENT SECRETARY
Credential:
Phone: 402-464-6667