Healthcare Provider Details

I. General information

NPI: 1164528956
Provider Name (Legal Business Name): OMAHA GASTROENTEROLOGY CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 MERCY RD SUITE 330
OMAHA NE
68124-2372
US

IV. Provider business mailing address

7710 MERCY RD SUITE 330
OMAHA NE
68124-2372
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-8040
  • Fax: 402-397-8558
Mailing address:
  • Phone: 402-397-8040
  • Fax: 402-397-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number17283
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111313
License Number StateNE

VIII. Authorized Official

Name: MS. MARTHA ANN AROUNI
Title or Position: OWNER
Credential: M.D.
Phone: 402-397-8040