Healthcare Provider Details

I. General information

NPI: 1073830410
Provider Name (Legal Business Name): MIDLANDS NEUROLOGICAL & HEADACHE CENTER AND JAN J GOLNICK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8552 CASS STREET SUITE 300
OMAHA NE
68114-3570
US

IV. Provider business mailing address

8552 CASS STREET SUITE 300
OMAHA NE
68114-3570
US

V. Phone/Fax

Practice location:
  • Phone: 402-926-4200
  • Fax: 402-926-4210
Mailing address:
  • Phone: 402-926-4200
  • Fax: 402-926-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number144661
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number14661
License Number StateNE

VIII. Authorized Official

Name: DR. JAN JERZY GOLNICK
Title or Position: PRESIDENT
Credential: MD
Phone: 402-926-4200