Healthcare Provider Details

I. General information

NPI: 1083945646
Provider Name (Legal Business Name): SUBURBAN WEST MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 S 87TH ST
OMAHA NE
68124-3039
US

IV. Provider business mailing address

2722 S 87TH ST
OMAHA NE
68124-3039
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-2205
  • Fax: 402-397-0901
Mailing address:
  • Phone: 402-397-2205
  • Fax: 402-397-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10221
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10221
License Number StateNE

VIII. Authorized Official

Name: DR. LEE F MCNAMARA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-397-2205