Healthcare Provider Details

I. General information

NPI: 1053249847
Provider Name (Legal Business Name): JEREMY VINTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983075 NEBRASKA MEDICAL CTR
OMAHA NE
68198-3075
US

IV. Provider business mailing address

983075 NEBRASKA MEDICAL CTR
OMAHA NE
68198-3075
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-7200
  • Fax: 402-559-9344
Mailing address:
  • Phone: 402-559-7200
  • Fax: 402-559-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10534
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: