Healthcare Provider Details

I. General information

NPI: 1740333608
Provider Name (Legal Business Name): MIDWEST ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6829 N 72 ST SUITE 7500
OMAHA NE
68122-1790
US

IV. Provider business mailing address

6829 N 72 ST SUITE 7500
OMAHA NE
68122-1790
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-2663
  • Fax: 402-572-2671
Mailing address:
  • Phone: 402-572-2663
  • Fax: 402-572-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENT L HARTLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-572-2663