Provider Demographics
NPI:1407225477
Name:ESSENTIAL FAMILY MEDICINE OF OMAHA, LLC
Entity Type:Organization
Organization Name:ESSENTIAL FAMILY MEDICINE OF OMAHA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-319-5298
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-0037
Mailing Address - Country:US
Mailing Address - Phone:402-319-5298
Mailing Address - Fax:402-505-7128
Practice Address - Street 1:17520 WRIGHT ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4657
Practice Address - Country:US
Practice Address - Phone:402-991-5353
Practice Address - Fax:402-991-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty