Healthcare Provider Details

I. General information

NPI: 1831125418
Provider Name (Legal Business Name): MIDWEST REGIONAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S 144TH ST STE 280
OMAHA NE
68144-5252
US

IV. Provider business mailing address

2727 S 144TH ST STE 280
OMAHA NE
68144-5252
US

V. Phone/Fax

Practice location:
  • Phone: 402-745-1145
  • Fax: 833-985-0140
Mailing address:
  • Phone: 402-745-1145
  • Fax: 833-985-0140

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

VIII. Authorized Official

Name: KENNETH L BLAD
Title or Position: M.D./CEO
Credential: M.D.
Phone: 402-745-1145