Provider Demographics
NPI:1083739452
Name:MEERA DEWAN P C
Entity Type:Organization
Organization Name:MEERA DEWAN P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FRONT OFFICE FACILITATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AVRIL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-330-4770
Mailing Address - Street 1:11912 ELM ST
Mailing Address - Street 2:SUITE 26
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4443
Mailing Address - Country:US
Mailing Address - Phone:402-330-4770
Mailing Address - Fax:402-330-2711
Practice Address - Street 1:11912 ELM ST
Practice Address - Street 2:SUITE 26
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4443
Practice Address - Country:US
Practice Address - Phone:402-330-4770
Practice Address - Fax:402-330-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15521261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099292Medicare PIN