MEDICARE: UPSTREAM ROOT CAUSE MEDICINE

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	202D00000X	Integrative Medicine Physician

General Provider Information

NPI Number	:	1326981010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPSTREAM ROOT CAUSE MEDICINE

Provider Business Mailing Address
First Line	:	8031 W CENTER RD STE 221
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3134
Country	:	US
Telephone Number	:	402-343-7963
Fax Number	:	866-305-8318

Provider Business Practice Location Address
First Line	:	8031 W CENTER RD STE 221
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3134
Country	:	US
Telephone Number	:	402-343-7963
Fax Number	:	866-305-8318

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JORGE LUIS MORENO
Credential	:	DO
Telephone Number	:	402-343-7963

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “UPSTREAM ROOT CAUSE MEDICINE ” Practice Location

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