Healthcare Provider Details

I. General information

NPI: 1427872480
Provider Name (Legal Business Name): THIRD JOHN HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 FARNAM ST
OMAHA NE
68102-1880
US

IV. Provider business mailing address

1299 FARNAM ST
OMAHA NE
68102-1880
US

V. Phone/Fax

Practice location:
  • Phone: 800-388-4047
  • Fax:
Mailing address:
  • Phone: 800-388-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE FURNACE
Title or Position: PRESIDENT
Credential: NP
Phone: 800-388-4047