Provider Demographics
NPI:1588667950
Name:NEBRASKA SPINE CENTER, LLP
Entity Type:Organization
Organization Name:NEBRASKA SPINE CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:RANDAL
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-496-0404
Mailing Address - Street 1:13616 CALIFORNIA STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5336
Mailing Address - Country:US
Mailing Address - Phone:402-496-0404
Mailing Address - Fax:402-496-0517
Practice Address - Street 1:13616 CALIFORNIA ST
Practice Address - Street 2:STE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5335
Practice Address - Country:US
Practice Address - Phone:402-496-0404
Practice Address - Fax:402-496-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14918207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0525915OtherIOWA MEDICAID
NECN7071OtherRAILROAD MEDICARE
NECN7071OtherRAILROAD MEDICARE
NE5645430001Medicare NSC