Provider Demographics
NPI:1285683870
Name:NEBRASKA ORTHOPAEDIC AND SPORTS MEDICINE P.C.
Entity Type:Organization
Organization Name:NEBRASKA ORTHOPAEDIC AND SPORTS MEDICINE P.C.
Other - Org Name:NEBRASKA ORTHOPAEDIC AND SPORTS MEDICINE P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BUESSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-488-3322
Mailing Address - Street 1:575 S 70TH ST
Mailing Address - Street 2:NEBRASKA ORTHOPAEDIC AND SPORTS MEDICINE P.C. SUITE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2471
Mailing Address - Country:US
Mailing Address - Phone:402-488-3322
Mailing Address - Fax:402-488-1172
Practice Address - Street 1:575 S 70TH ST
Practice Address - Street 2:NEBRASKA ORTHOPAEDIC AND SPORTS MEDICINE P.C. SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-488-3322
Practice Address - Fax:402-488-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========54OtherMEDICAID GROUP DME
NE=========13Medicaid
NE=========54OtherMEDICAID GROUP DME
NE0344050001Medicare NSC