Healthcare Provider Details

I. General information

NPI: 1679888317
Provider Name (Legal Business Name): BIENESTAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 N 98TH ST SUITE 289
OMAHA NE
68114-2370
US

IV. Provider business mailing address

643 N 98TH ST SUITE 289
OMAHA NE
68114-2370
US

V. Phone/Fax

Practice location:
  • Phone: 402-909-6046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number13092
License Number StateNE

VIII. Authorized Official

Name: MICHAEL JONES
Title or Position: CEO
Credential:
Phone: 402-909-6046