Healthcare Provider Details

I. General information

NPI: 1578636254
Provider Name (Legal Business Name): ADULT MEDICINE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 NICHOLAS ST STE 202
OMAHA NE
68114-2188
US

IV. Provider business mailing address

10020 NICHOLAS ST STE 202
OMAHA NE
68114-2188
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-0137
  • Fax: 402-991-0236
Mailing address:
  • Phone: 402-991-0137
  • Fax: 402-991-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS A RUSSELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-991-0137