MEDICARE: COVENTRY HEALTH CARE OF NEBRASKA INC.

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1821656695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENTRY HEALTH CARE OF NEBRASKA INC.

Provider Business Mailing Address
First Line	:	15950 W DODGE RD STE 400
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-4009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15950 W DODGE RD STE 400
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-4009
Country	:	US
Telephone Number	:	515-253-4050
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT, CHIEF OFFICER
Name	:	MR. RICHARD SLOMA
Credential	:
Telephone Number	:	515-253-4050

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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