Provider Demographics
NPI:1528212438
Name:NEBRASKA MYOFUNCTIONAL SPECIALTIES
Entity Type:Organization
Organization Name:NEBRASKA MYOFUNCTIONAL SPECIALTIES
Other - Org Name:NEBRASKA MYOFUNCTIONAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CERTIFIED OROFACIAL MYOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRINKMAN-FALTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHRDH, BSDH, MS, COM
Authorized Official - Phone:402-759-1762
Mailing Address - Street 1:8911 WHISPERING WIND RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9278
Mailing Address - Country:US
Mailing Address - Phone:402-759-1762
Mailing Address - Fax:
Practice Address - Street 1:8911 WHISPERING WIND RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9278
Practice Address - Country:US
Practice Address - Phone:402-759-1762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67251K00000X
251S00000X, 261QH0100X
NE613261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026255300Medicaid