Healthcare Provider Details

I. General information

NPI: 1407087489
Provider Name (Legal Business Name): NEBRASKA ORTHOPAEDIC HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S 144TH ST
OMAHA NE
68144-5225
US

IV. Provider business mailing address

2808 S 143RD PLZ
OMAHA NE
68144-5611
US

V. Phone/Fax

Practice location:
  • Phone: 402-637-0608
  • Fax: 402-637-0645
Mailing address:
  • Phone: 402-637-0608
  • Fax: 402-637-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: TARA L WISDOM
Title or Position: CFO
Credential:
Phone: 402-609-1002