Provider Demographics
NPI:1659414597
Name:MIDWEST ALLERGY AND ASTHMA CLINIC, P.C.
Entity Type:Organization
Organization Name:MIDWEST ALLERGY AND ASTHMA CLINIC, P.C.
Other - Org Name:MIDWEST ALLERGY & ASTHMA CLINIC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:V.P. - MANAGING SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-7400
Mailing Address - Street 1:16945 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2312
Mailing Address - Country:US
Mailing Address - Phone:402-397-7400
Mailing Address - Fax:402-397-0115
Practice Address - Street 1:16945 FRANCES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2312
Practice Address - Country:US
Practice Address - Phone:402-397-7400
Practice Address - Fax:402-397-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Not Answered2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty
Not Answered2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1812OtherNE BCBS GROUP #
IA0946848Medicaid
NE1812OtherNE BCBS GROUP #
NE=========00Medicaid
MO=========Medicaid
NE094947Medicare ID - Type UnspecifiedMEDICARE GROUP NO.