Healthcare Provider Details

I. General information

NPI: 1649304411
Provider Name (Legal Business Name): JAY A. RICH M.D. AND ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11920 BURT ST SUITE 165
OMAHA NE
68154-1598
US

IV. Provider business mailing address

11920 BURT ST SUITE 165
OMAHA NE
68154-1598
US

V. Phone/Fax

Practice location:
  • Phone: 402-431-4080
  • Fax: 402-951-2747
Mailing address:
  • Phone: 402-431-4080
  • Fax: 402-951-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number346
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number713
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13914
License Number StateNE

VIII. Authorized Official

Name: DR. JAY A. RICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-431-4080