Provider Demographics
NPI:1063478808
Name:O NEILL FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:O NEILL FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-336-2622
Mailing Address - Street 1:403 E HYNES AVE
Mailing Address - Street 2:
Mailing Address - City:O NEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1301
Mailing Address - Country:US
Mailing Address - Phone:402-336-2622
Mailing Address - Fax:402-336-3240
Practice Address - Street 1:403 E HYNES AVE
Practice Address - Street 2:
Practice Address - City:O NEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1301
Practice Address - Country:US
Practice Address - Phone:402-336-2622
Practice Address - Fax:402-336-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid