Healthcare Provider Details

I. General information

NPI: 1861578817
Provider Name (Legal Business Name): MID-CITY OB-GYN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 WEST CENTER ROAD SUITE 200
OMAHA NE
68124-2388
US

IV. Provider business mailing address

7205 WEST CENTER ROAD SUITE 200
OMAHA NE
68124-2388
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-6600
  • Fax: 402-397-8318
Mailing address:
  • Phone: 402-397-6600
  • Fax: 402-397-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KENT H SIEMERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-397-6600