Healthcare Provider Details

I. General information

NPI: 1770677601
Provider Name (Legal Business Name): MIDWEST MINOR MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14104 S ST
OMAHA NE
68137-2636
US

IV. Provider business mailing address

14104 S ST
OMAHA NE
68137-2636
US

V. Phone/Fax

Practice location:
  • Phone: 402-827-6710
  • Fax: 402-827-6731
Mailing address:
  • Phone: 402-964-2332
  • Fax: 402-964-2472

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: DR. LOUISE A WINTER
Title or Position: PRESIDENT
Credential: MD
Phone: 402-964-2332