Healthcare Provider Details

I. General information

NPI: 1093991531
Provider Name (Legal Business Name): CALLAHAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 FARNAM ST SUITE 655
OMAHA NE
68131-2806
US

IV. Provider business mailing address

14067 HARTMAN AVE
OMAHA NE
68164-5103
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2665
  • Fax: 402-552-2655
Mailing address:
  • Phone: 402-301-5188
  • Fax: 402-552-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TY SCOTT CALLAHAN
Title or Position: PRESIDENT CEO
Credential: PHD
Phone: 402-301-5188