Healthcare Provider Details

I. General information

NPI: 1912009374
Provider Name (Legal Business Name): DOUGLAS COUNTY NEBRASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 WOOLWORTH AVE
OMAHA NE
68105-1899
US

IV. Provider business mailing address

4102 WOOLWORTH AVE
OMAHA NE
68105-1899
US

V. Phone/Fax

Practice location:
  • Phone: 402-444-7000
  • Fax: 402-444-7369
Mailing address:
  • Phone: 402-444-7000
  • Fax: 402-444-7369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ERIN NELSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 402-444-7041