Healthcare Provider Details

I. General information

NPI: 1780854216
Provider Name (Legal Business Name): NEBRASKA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4239 FARNAM ST #100
OMAHA NE
68131-2868
US

IV. Provider business mailing address

4239 FARNAM ST #100
OMAHA NE
68131-2868
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2320
  • Fax: 402-552-2330
Mailing address:
  • Phone: 402-552-2320
  • Fax: 402-552-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENN A FOSDICK
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 402-552-2040