Healthcare Provider Details

I. General information

NPI: 1598781114
Provider Name (Legal Business Name): MCKENNA RADIATION ONCOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 MERCY RD DEPT OF RADIATION ONCOLOGY
OMAHA NE
68124-2319
US

IV. Provider business mailing address

PO BOX 241359
OMAHA NE
68124-5359
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-6485
  • Fax: 402-398-6621
Mailing address:
  • Phone: 402-398-5994
  • Fax: 402-398-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK JAMES MCKENNA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 402-398-5994