Healthcare Provider Details

I. General information

NPI: 1720138472
Provider Name (Legal Business Name): PAIN MANAGEMENT CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11819 MIRACLE HILLS DR SUITE 202
OMAHA NE
68154-4428
US

IV. Provider business mailing address

11819 MIRACLE HILLS DR SUITE 202
OMAHA NE
68154-4428
US

V. Phone/Fax

Practice location:
  • Phone: 402-445-4800
  • Fax: 402-445-4848
Mailing address:
  • Phone: 402-445-4800
  • Fax: 402-445-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20620
License Number StateNE

VIII. Authorized Official

Name: PATRICIA OR PAT J. CHUDOMELKA
Title or Position: PHYSICIAN OWNER
Credential: M.D., PH.D.
Phone: 402-445-4800