Healthcare Provider Details

I. General information

NPI: 1730230590
Provider Name (Legal Business Name): MEDICAL PAIN CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7837 CHICAGO PLZ
OMAHA NE
68114-3653
US

IV. Provider business mailing address

PO BOX 2178
OMAHA NE
68103-2178
US

V. Phone/Fax

Practice location:
  • Phone: 402-341-8023
  • Fax: 402-341-3616
Mailing address:
  • Phone: 402-341-8023
  • Fax: 402-341-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number16930
License Number StateNE

VIII. Authorized Official

Name: MS. NANCI J VIEYRA
Title or Position: BILLING MANAGER
Credential:
Phone: 402-978-5151