MEDICARE: MEDICAL PAIN CENTER 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	208VP0000X	Pain Medicine Physician	16930	NE

General Provider Information

NPI Number	:	1730230590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PAIN CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 2178
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-2178
Country	:	US
Telephone Number	:	402-341-8023
Fax Number	:	402-341-3616

Provider Business Practice Location Address
First Line	:	7837 CHICAGO PLZ
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3653
Country	:	US
Telephone Number	:	402-341-8023
Fax Number	:	402-341-3616

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. NANCI J VIEYRA
Credential	:
Telephone Number	:	402-978-5151

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

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