Healthcare Provider Details

I. General information

NPI: 1588667950
Provider Name (Legal Business Name): NEBRASKA SPINE CENTER, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13616 CALIFORNIA ST STE 100
OMAHA NE
68154-5335
US

IV. Provider business mailing address

13616 CALIFORNIA STREET SUITE 100
OMAHA NE
68154-5336
US

V. Phone/Fax

Practice location:
  • Phone: 402-496-0404
  • Fax: 402-496-0517
Mailing address:
  • Phone: 402-496-0404
  • Fax: 402-496-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number14918
License Number StateNE

VIII. Authorized Official

Name: DR. HOWARD RANDAL WOODWARD
Title or Position: PRESIDENT
Credential: MD
Phone: 402-496-0404