Healthcare Provider Details

I. General information

NPI: 1659414597
Provider Name (Legal Business Name): MIDWEST ALLERGY AND ASTHMA CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16945 FRANCES ST
OMAHA NE
68130-2312
US

IV. Provider business mailing address

16945 FRANCES ST
OMAHA NE
68130-2312
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-7400
  • Fax: 402-397-0115
Mailing address:
  • Phone: 402-397-7400
  • Fax: 402-397-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WHITE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 402-397-7455