Healthcare Provider Details

I. General information

NPI: 1356345318
Provider Name (Legal Business Name): NEBRASKA ORTHOPAEDIC HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 SOUTH 143RD PLAZA
OMAHA NE
68144-5611
US

IV. Provider business mailing address

2808 SOUTH 143RD PLAZA
OMAHA NE
68144-5611
US

V. Phone/Fax

Practice location:
  • Phone: 402-637-0600
  • Fax: 402-637-0705
Mailing address:
  • Phone: 402-637-0600
  • Fax: 402-637-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH000105
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberH000105
License Number StateNE

VIII. Authorized Official

Name: TARA L WISDOM
Title or Position: CFO
Credential:
Phone: 402-609-1002