Provider Demographics
NPI:1144741406
Name:MULTICARE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:MULTICARE MEDICAL GROUP PC
Other - Org Name:PAIN WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOECKENHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-505-7989
Mailing Address - Street 1:741 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-6269
Mailing Address - Country:US
Mailing Address - Phone:402-505-7989
Mailing Address - Fax:402-932-8863
Practice Address - Street 1:701 PINNACLE DR STE 105
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6228
Practice Address - Country:US
Practice Address - Phone:402-505-7989
Practice Address - Fax:402-932-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty