Healthcare Provider Details

I. General information

NPI: 1316863699
Provider Name (Legal Business Name): THAD JAMES METCALFE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S 42ND ST & EMILE ST
OMAHA NE
68198-0001
US

IV. Provider business mailing address

301 N 46TH ST APT 2104
OMAHA NE
68132-3267
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: