Provider Demographics
NPI:1689173924
Name:OMAHA FERTILITY & GYNECOLOGY CLINIC, LLC
Entity Type:Organization
Organization Name:OMAHA FERTILITY & GYNECOLOGY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUPOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MA, FACOG
Authorized Official - Phone:402-630-6485
Mailing Address - Street 1:615 N 159TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4611 S 96TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1202
Practice Address - Country:US
Practice Address - Phone:402-630-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty