Provider Demographics
NPI:1508185000
Name:OMAHA PAIN PHYSICIANS LLC
Entity Type:Organization
Organization Name:OMAHA PAIN PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRZEGORZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:4023-431-1701
Mailing Address - Street 1:PO BOX 241296
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-5296
Mailing Address - Country:US
Mailing Address - Phone:402-343-1701
Mailing Address - Fax:402-573-6279
Practice Address - Street 1:2808 S 80TH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3253
Practice Address - Country:US
Practice Address - Phone:402-343-1701
Practice Address - Fax:402-573-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22596207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty