=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366550089
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS E MARTIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 06/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 N 190TH PLZ STE. #1100
-----------------------------------------------------
City | ELKHORN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68022-3917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-815-1700
-----------------------------------------------------
Fax | 402-815-1959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3755
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68103-0755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-354-2100
-----------------------------------------------------
Fax | 402-351-2155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 13427
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------