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General NPI Number Information
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NPI Number | 1447526157
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Entity Type | Organization
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Legal Business Name | ST. GEORGE FAMILY PRACTICE P.C
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 3440 S 50TH ST
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City | OMAHA
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State | NE
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Zip | 68106-3829
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Country | US
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Telephone | 402-404-6061
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Fax | 402-933-1374
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Provider Business Mailing Address
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Address Line | 12428 ROSE LN
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City | OMAHA
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State | NE
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Zip | 68154-1469
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Country | US
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Telephone | 402-305-8755
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Fax | 402-933-1374
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Authorized Official
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Title or Position | PHYSICAN/OWNER
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Name | MOHSEN ABOU SEIF
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Credential | MD
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Telephone | 402-305-8755
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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 | 25251
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License Number State | NE
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