Healthcare Provider Details

I. General information

NPI: 1366295479
Provider Name (Legal Business Name): MEDICINE IN MOTION CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 N 72ND ST
OMAHA NE
68114-1924
US

IV. Provider business mailing address

PO BOX 632323
CINCINNATI OH
45263-2323
US

V. Phone/Fax

Practice location:
  • Phone: 402-249-6136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA WESTER
Title or Position: OWNER
Credential: MD
Phone: 402-249-6136