Healthcare Provider Details

I. General information

NPI: 1750443503
Provider Name (Legal Business Name): CHILDREN'S PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 W DODGE RD SUITE 280
OMAHA NE
68114-3451
US

IV. Provider business mailing address

8401 W DODGE RD SUITE 280
OMAHA NE
68114-3451
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-6877
  • Fax: 402-955-6880
Mailing address:
  • Phone: 402-955-6877
  • Fax: 402-955-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNE

VIII. Authorized Official

Name: SHIELA STEVENSON
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 402-955-6810