Provider Demographics
NPI:1275587743
Name:HOODY & LANSPA FAMILY PRACTICE P C
Entity Type:Organization
Organization Name:HOODY & LANSPA FAMILY PRACTICE P C
Other - Org Name:MIDTOWN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSH
Authorized Official - Suffix:
Authorized Official - Credentials:CMA/LRT
Authorized Official - Phone:402-558-2500
Mailing Address - Street 1:4920 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3219
Mailing Address - Country:US
Mailing Address - Phone:402-558-6625
Mailing Address - Fax:402-558-5013
Practice Address - Street 1:4920 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3219
Practice Address - Country:US
Practice Address - Phone:402-558-6625
Practice Address - Fax:402-558-5013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOODY & LANSPA FAMILY PRACTICE P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-20
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
261524OtherMEDICARE NUMBER FOR DR. ZAWAIDEH
261524OtherMEDICARE NUMBER FOR DR. ZAWAIDEH
NE=========00Medicaid