Healthcare Provider Details

I. General information

NPI: 1124963434
Provider Name (Legal Business Name): MEDIFAST URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 N 167TH CT
OMAHA NE
68116-8064
US

IV. Provider business mailing address

3830 N 167TH CT
OMAHA NE
68116-8064
US

V. Phone/Fax

Practice location:
  • Phone: 402-965-4000
  • Fax: 402-965-4001
Mailing address:
  • Phone: 402-965-4000
  • Fax: 402-965-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JON ROBERT WILSON
Title or Position: OWNER
Credential:
Phone: 402-965-4000