Healthcare Provider Details

I. General information

NPI: 1104078542
Provider Name (Legal Business Name): BRITT A. THEDINGER, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 W DODGE ROAD SUITE 200
OMAHA NE
68114-3318
US

IV. Provider business mailing address

9202 WEST DODGE ROAD SUITE 200
OMAHA NE
68114-3318
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-3277
  • Fax: 402-933-2216
Mailing address:
  • Phone: 402-933-3277
  • Fax: 402-933-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number18188
License Number StateNE

VIII. Authorized Official

Name: DR. BRITT ASHLEY THEDINGER
Title or Position: CEO
Credential: MD
Phone: 402-933-3277