Healthcare Provider Details

I. General information

NPI: 1821262924
Provider Name (Legal Business Name): OMAHA BARIATRIC MEDICINE , P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 N 167TH CT
OMAHA NE
68116-8067
US

IV. Provider business mailing address

3830 N 167TH CT
OMAHA NE
68116-8067
US

V. Phone/Fax

Practice location:
  • Phone: 402-496-7192
  • Fax:
Mailing address:
  • Phone: 402-496-7192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number20638
License Number StateNE

VIII. Authorized Official

Name: CINDY M MCATEE
Title or Position: NURSE
Credential: L.P.N.
Phone: 402-496-7192