MEDICARE: ONE WORLD COMMUNITY HEALTH CENTERS 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	333600000X	Pharmacy	2660	NE
2	333600000X	Pharmacy	402	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

General Provider Information

NPI Number	:	1902837917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE WORLD COMMUNITY HEALTH CENTERS INC.

Provider Business Mailing Address
First Line	:	4920 SOUTH 30TH STREET
Second Line	:	STE 103
City	:	OMAHA
State	:	NE
Zip	:	68107-1656
Country	:	US
Telephone Number	:	402-502-5832
Fax Number	:	402-502-5841

Provider Business Practice Location Address
First Line	:	4920 S 30TH ST
Second Line	:	STE 103
City	:	OMAHA
State	:	NE
Zip	:	68107-1590
Country	:	US
Telephone Number	:	402-502-5832
Fax Number	:	402-502-5841

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ANDREA M. SKOLKIN
Credential	:
Telephone Number	:	402-502-8842

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/04/2010

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