Healthcare Provider Details

I. General information

NPI: 1912712886
Provider Name (Legal Business Name): RICK THEILER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9416 WESTERN PLZ APT 2
OMAHA NE
68114-2553
US

IV. Provider business mailing address

7110 F ST
OMAHA NE
68117-1014
US

V. Phone/Fax

Practice location:
  • Phone: 402-431-3944
  • Fax:
Mailing address:
  • Phone: 531-365-8663
  • Fax: 402-455-2542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberG15004836
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: