Healthcare Provider Details

I. General information

NPI: 1740707447
Provider Name (Legal Business Name): DOUGLAS COUNTY NEBRASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/21/2022
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 WOOLWORTH AVE
OMAHA NE
68105-1851
US

IV. Provider business mailing address

4102 WOOLWORTH AVE
OMAHA NE
68105-1899
US

V. Phone/Fax

Practice location:
  • Phone: 402-444-7000
  • Fax:
Mailing address:
  • Phone: 402-444-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIN NELSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-444-7041