Provider Demographics
NPI: | 1538119466 |
---|---|
Name: | BIRDWELL, MAURICE DAVID (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MAURICE |
Middle Name: | DAVID |
Last Name: | BIRDWELL |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2727 S 144TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | OMAHA |
Mailing Address - State: | NE |
Mailing Address - Zip Code: | 68144-5225 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 402-609-1500 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2727 S 144TH ST |
Practice Address - Street 2: | |
Practice Address - City: | OMAHA |
Practice Address - State: | NE |
Practice Address - Zip Code: | 68144-5225 |
Practice Address - Country: | US |
Practice Address - Phone: | 402-609-1500 |
Practice Address - Fax: | 402-426-1135 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-11 |
Last Update Date: | 2023-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 20015 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
930039867 | Other | RAILROAD MEDICARE | |
IA | 0922658 | Medicaid | |
002475 | Other | RAILROAD MEDICARE - GRP | |
NE | 47064207113 | Medicaid | |
G28827 | Medicare UPIN | ||
NE | 47064207113 | Medicaid | |
092250 | Medicare ID - Type Unspecified | GRP |