Healthcare Provider Details

I. General information

NPI: 1033371364
Provider Name (Legal Business Name): OMAHA PAIN MANAGEMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 07/21/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10784 V ST
OMAHA NE
68127-2952
US

IV. Provider business mailing address

PO BOX 241277
OMAHA NE
68124-5277
US

V. Phone/Fax

Practice location:
  • Phone: 402-885-7800
  • Fax:
Mailing address:
  • Phone: 317-574-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DANIEL BORVAN
Title or Position: PRESIDENT
Credential: CRNA
Phone: 815-462-8470