MEDICARE: ANN EDMUNDS MD

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	207YP0228X	Pediatric Otolaryngology Physician	20857	NE

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
2	34176	OTHER	NE	BCBS
3	10-00173	OTHER		UNITED HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417995192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN EDMUNDS MD

Provider Business Mailing Address
First Line	:	17030 LAKESIDE HILLS PLZ
Second Line	:	SUITE 204
City	:	OMAHA
State	:	NE
Zip	:	68130-2396
Country	:	US
Telephone Number	:	402-758-5600
Fax Number	:	402-758-5169

Provider Business Practice Location Address
First Line	:	17030 LAKESIDE HILLS PLZ
Second Line	:	SUITE 204
City	:	OMAHA
State	:	NE
Zip	:	68130-2396
Country	:	US
Telephone Number	:	402-758-5600
Fax Number	:	402-758-5169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	05/13/2010

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Directions to “ ANN EDMUNDS MD” Practice Location

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