Provider Demographics
NPI:1043290406
Name:OMAHA VASCULAR SPECIALISTS LLC
Entity Type:Organization
Organization Name:OMAHA VASCULAR SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-393-6624
Mailing Address - Street 1:8111 DODGE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4129
Mailing Address - Country:US
Mailing Address - Phone:402-393-6624
Mailing Address - Fax:402-393-6635
Practice Address - Street 1:8111 DODGE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4129
Practice Address - Country:US
Practice Address - Phone:402-393-6624
Practice Address - Fax:402-393-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA770002841OtherRAILROAD MEDICARE
NECH4571OtherRAILROAD MEDICARE
NECH4571OtherRAILROAD MEDICARE
NE098994Medicare PIN