Healthcare Provider Details

I. General information

NPI: 1750877510
Provider Name (Legal Business Name): COLLABORATIVE CARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 N 140TH ST
OMAHA NE
68164-5400
US

IV. Provider business mailing address

3410 N 140TH ST
OMAHA NE
68164-5400
US

V. Phone/Fax

Practice location:
  • Phone: 402-317-6491
  • Fax:
Mailing address:
  • Phone: 402-317-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. TAMARA DOEHNER
Title or Position: OWNER
Credential: MD
Phone: 402-317-6491