Provider Demographics
NPI:1407087489
Name:NEBRASKA ORTHOPAEDIC HOSPITAL LLC
Entity Type:Organization
Organization Name:NEBRASKA ORTHOPAEDIC HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WISDOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-609-1002
Mailing Address - Street 1:2808 S 143RD PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5611
Mailing Address - Country:US
Mailing Address - Phone:402-637-0608
Mailing Address - Fax:402-637-0645
Practice Address - Street 1:2727 S 144TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5225
Practice Address - Country:US
Practice Address - Phone:402-637-0608
Practice Address - Fax:402-637-0645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEBRASKA ORTHOPAEDIC HOSPITAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1408Medicare PIN