MEDICARE: MIDWEST FAMILY PHYSICIANS. 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	207Q00000X	Family Medicine Physician		NE

General Provider Information

NPI Number	:	1588682413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST FAMILY PHYSICIANS. PC

Provider Business Mailing Address
First Line	:	14450 EAGLE RUN DR
Second Line	:	SUITE 104
City	:	OMAHA
State	:	NE
Zip	:	68116-1493
Country	:	US
Telephone Number	:	402-498-0380
Fax Number	:	402-498-0355

Provider Business Practice Location Address
First Line	:	14450 EAGLE RUN DR
Second Line	:	SUITE 104
City	:	OMAHA
State	:	NE
Zip	:	68116-1493
Country	:	US
Telephone Number	:	402-498-0380
Fax Number	:	402-498-0355

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	THERESA M RYAN
Credential	:
Telephone Number	:	402-498-0380

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/10/2008

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