Healthcare Provider Details

I. General information

NPI: 1780135319
Provider Name (Legal Business Name): NEBRASKA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 LEAVENWORTH STREET
OMAHA NE
68198-5610
US

IV. Provider business mailing address

4014 LEAVENWORTH STREET
OMAHA NE
68105
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-7999
  • Fax: 402-552-7792
Mailing address:
  • Phone: 402-552-3927
  • Fax: 402-559-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number3114
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: APRIL M. DAVIDSON
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 402-559-3287