Healthcare Provider Details

I. General information

NPI: 1356896070
Provider Name (Legal Business Name): MILLARD PREMIER MEDICINE AND AESTHETICS, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5062 S 155TH ST STE 2
OMAHA NE
68137-5040
US

IV. Provider business mailing address

5062 S 155TH ST STE 2
OMAHA NE
68137-5040
US

V. Phone/Fax

Practice location:
  • Phone: 402-810-9494
  • Fax: 402-810-9498
Mailing address:
  • Phone: 402-810-9494
  • Fax: 402-920-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL SULLIVAN
Title or Position: OPERATING PARTNER
Credential:
Phone: 402-681-4030