Provider Demographics
NPI:1457308991
Name:O'MALLEY, TERRANCE KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:KEVIN
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T.
Other - Middle Name:KEVIN
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8005 FARNAM DR STE 305
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3426
Mailing Address - Country:US
Mailing Address - Phone:402-390-4111
Mailing Address - Fax:402-390-4115
Practice Address - Street 1:8005 FARNAM DR STE 305
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3426
Practice Address - Country:US
Practice Address - Phone:402-390-4111
Practice Address - Fax:402-390-4115
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17796207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09-01140OtherSHARE ADVANTAGE/LAKESIDE
NE47063010113Medicaid
NE2448OtherMIDLANDS CHOICE
NE03823OtherBCBS OF NEBRASKA
NE09-11001OtherSHARE ADVANTAGE/MERCY RD
NE200012944OtherRAILROAD MEDICARE
NE0975672Medicaid
NE200012944OtherRAILROAD MEDICARE
NE2000192344Medicare PIN
NE0975672Medicaid