Healthcare Provider Details

I. General information

NPI: 1619493236
Provider Name (Legal Business Name): ERIC ROBERT URBANEC MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 S 156TH ST
OMAHA NE
68130-1906
US

IV. Provider business mailing address

SKUTT CATHOLIC HIGH SCHOOL 3131 S. 156TH ST.
OMAHA NE
68130
US

V. Phone/Fax

Practice location:
  • Phone: 402-333-0818
  • Fax:
Mailing address:
  • Phone: 402-681-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number524
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: