Provider Demographics
NPI:1508053943
Name:OMAHA FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:OMAHA FAMILY MEDICINE, P.C.
Other - Org Name:CHARLES STONER, M.D. FAMILY PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:STONER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:402-991-7000
Mailing Address - Street 1:17841 PIERCE PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:402-991-7000
Mailing Address - Fax:402-991-7999
Practice Address - Street 1:17841 PIERCE PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-991-7000
Practice Address - Fax:402-991-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024979400Medicaid
NE2801010835OtherCLIA
NE100249794001Medicaid
NE100249794001Medicaid
NEE26745Medicare UPIN
NE100249794001Medicaid
NE099354Medicare PIN