Healthcare Provider Details

I. General information

NPI: 1497036651
Provider Name (Legal Business Name): OSTEOARTHRITIS ASSOCIATES OF NEBRASKA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 F ST SUITE 121
OMAHA NE
68137-1007
US

IV. Provider business mailing address

14440 F ST SUITE 121
OMAHA NE
68137-1007
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-8255
  • Fax:
Mailing address:
  • Phone: 402-934-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number601
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3024
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111325
License Number StateNE

VIII. Authorized Official

Name: CANDICE CARTER
Title or Position: BUSINESS MANAGER
Credential: APRN
Phone: 402-706-6027