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General NPI Number Information
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NPI Number | 1104666536
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Entity Type | Organization
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Legal Business Name | ATLAS MEDICAL NEBRASKA LLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 8214 F ST STE C
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City | OMAHA
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State | NE
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Zip | 68127-1740
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Country | US
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Telephone | 402-331-2273
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Fax | 402-933-4255
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Provider Business Mailing Address
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Address Line | 8214 F ST STE C
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City | OMAHA
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State | NE
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Zip | 68127-1740
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Country | US
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Telephone | 402-331-2273
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Fax | 402-933-4255
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Authorized Official
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Title or Position | CEO
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Name | GREGORY MANGUM
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Credential | RN
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Telephone | 435-514-5646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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