Healthcare Provider Details

I. General information

NPI: 1821003294
Provider Name (Legal Business Name): DOCTORS FOR SENIOR HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18011 OAK STREET UNIT 18011A
OMAHA NE
68130
US

IV. Provider business mailing address

18011 OAK ST STE A
OMAHA NE
68130-6057
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-9454
  • Fax: 402-505-8209
Mailing address:
  • Phone: 402-435-1400
  • Fax: 402-435-1404

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: DAVID G SHARP
Title or Position: PRESIDENT
Credential:
Phone: 402-758-5800