Provider Demographics
NPI:1033371364
Name:OMAHA PAIN MANAGEMENT CENTER INC
Entity Type:Organization
Organization Name:OMAHA PAIN MANAGEMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BORVAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:815-462-8470
Mailing Address - Street 1:PO BOX 241277
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-5277
Mailing Address - Country:US
Mailing Address - Phone:317-574-8868
Mailing Address - Fax:
Practice Address - Street 1:10784 V ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-2952
Practice Address - Country:US
Practice Address - Phone:402-885-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty