Healthcare Provider Details

I. General information

NPI: 1992730477
Provider Name (Legal Business Name): PULMONARY MEDICINE INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 FARNAM ST #470
OMAHA NE
68131-2806
US

IV. Provider business mailing address

4242 FARNAM ST #470
OMAHA NE
68131-2806
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-9875
  • Fax: 402-552-9876
Mailing address:
  • Phone: 402-552-9875
  • Fax: 402-552-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD S YATES
Title or Position: M.D./PRESIDENT
Credential: M.D.
Phone: 402-552-9875