=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780039354
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEBRASKA PAIN MANAGEMENT PHYSICIANS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2016
-----------------------------------------------------
Last Update Date | 07/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 LAKERIDGE DR SUITE 100
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68701-2558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-316-4027
-----------------------------------------------------
Fax | 402-884-8751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 LAKERIDGE DR SUITE 100
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68701-2558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-316-4027
-----------------------------------------------------
Fax | 402-884-8751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL BILLING MANAGER
-----------------------------------------------------
Name | KATHY ANN LAMAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-884-3971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 21621
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 21621
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------