Healthcare Provider Details

I. General information

NPI: 1083946149
Provider Name (Legal Business Name): METHODIST ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 NORTH 162 AVENUE SUITE 201
OMAHA NE
68118-2540
US

IV. Provider business mailing address

515 NORTH 162 AVENUE SUITE 201
OMAHA NE
68118-2540
US

V. Phone/Fax

Practice location:
  • Phone: 402-505-8708
  • Fax: 402-505-8748
Mailing address:
  • Phone: 402-505-8708
  • Fax: 402-505-8748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPENDING
License Number StateNE

VIII. Authorized Official

Name: DR. TYRON A. ALLI
Title or Position: OWNER AND MANAGER
Credential: M.D.
Phone: 402-397-7057