Provider Demographics
NPI:1164528956
Name:OMAHA GASTROENTEROLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:OMAHA GASTROENTEROLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AROUNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-8040
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-397-8040
Mailing Address - Fax:402-397-8558
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:SUITE 330
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-397-8040
Practice Address - Fax:402-397-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17283207RG0100X
NE111313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1164528956Medicaid
NE288920900OtherUS DEPT OF LABOR
SD1164528956Medicaid
NE=========13Medicaid
IL=========6812401Medicaid
NE098947Medicare PIN
NECG1367Medicare PIN