Healthcare Provider Details

I. General information

NPI: 1851496947
Provider Name (Legal Business Name): OMAHA CHILDRENS CINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19102 Q STREET STE 102 OMAHA CHILDRENS CLINIC P.C.
OMAHA NE
68135-1558
US

IV. Provider business mailing address

19102 Q STREET STE 102 OMAHA CHILDRENS CLINIC P.C.
OMAHA NE
68135-1558
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-5690
  • Fax: 402-330-5689
Mailing address:
  • Phone: 402-330-5690
  • Fax: 402-330-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19479
License Number StateNE

VIII. Authorized Official

Name: MR. JOHN J. VANN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-330-5690