Provider Demographics
NPI:1235360033
Name:PIONEER TOTALTRADE MEDICAL ALARM MEDICAL NUTRITION THERAPY SYSTEMS, LL
Entity Type:Organization
Organization Name:PIONEER TOTALTRADE MEDICAL ALARM MEDICAL NUTRITION THERAPY SYSTEMS, LL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:OVONLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMNT
Authorized Official - Phone:402-403-5700
Mailing Address - Street 1:2505 N 24TH ST
Mailing Address - Street 2:STE 310
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2252
Mailing Address - Country:US
Mailing Address - Phone:402-403-5700
Mailing Address - Fax:888-550-3609
Practice Address - Street 1:2505 N 24TH ST
Practice Address - Street 2:STE 310
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-2252
Practice Address - Country:US
Practice Address - Phone:402-403-5700
Practice Address - Fax:888-550-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE752133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty