Healthcare Provider Details

I. General information

NPI: 1649595448
Provider Name (Legal Business Name): NEBRASKA SPINE HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N 72ND ST 20300
OMAHA NE
68122-1709
US

IV. Provider business mailing address

6901 N 72ND ST 20300
OMAHA NE
68122-1709
US

V. Phone/Fax

Practice location:
  • Phone: 402-343-4415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: HOWARD R. WOODWARD
Title or Position: BOARD CHAIRMAN
Credential: M.D.
Phone: 402-496-0404