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General NPI Number Information
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NPI Number | 1528836376
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Entity Type | Organization
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Legal Business Name | OMAHA MINDFUL MEDICINE AND THERAPY LLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 2202 S 11TH ST
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City | OMAHA
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State | NE
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Zip | 68108-1014
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Country | US
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Telephone | 402-591-0334
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Fax |
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Provider Business Mailing Address
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Address Line | 8054 MARTHA ST
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City | OMAHA
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State | NE
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Zip | 68124-2247
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Country | US
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Telephone | 402-591-0334
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUPRIYA BHATIA
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Credential | M.D.
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Telephone | 402-591-0334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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