MEDICARE: ONCOLOGY HEMATOLOGY WEST, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174474183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONCOLOGY HEMATOLOGY WEST, PC

Provider Business Mailing Address
First Line	:	17201 WRIGHT ST STE 200
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68130-2042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17201 WRIGHT ST STE 204
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68130-2042
Country	:	US
Telephone Number	:	402-691-5102
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATIVE ASSISTANT
Name	:	MEGAN JACOBSEN
Credential	:
Telephone Number	:	531-444-1206

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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