Provider Demographics
NPI:1750491692
Name:SCHACK, STANLEY H (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:H
Last Name:SCHACK
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 STE 250
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5236
Mailing Address - Country:US
Mailing Address - Phone:402-778-5250
Mailing Address - Fax:402-778-5216
Practice Address - Street 1:2727 S 144TH ST STE 250
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5236
Practice Address - Country:US
Practice Address - Phone:402-778-5250
Practice Address - Fax:402-778-5216
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17654207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01376OtherBCBSNE
NE10026440200Medicaid
NE47071741700Medicaid
NE96887OtherRR MEDICARE
NE661OtherMIDLANDS CHOICE
IA0932343Medicaid
MO202042610Medicaid
NE1000022OtherSHARE ADVANTAGE
NEB68080Medicare UPIN
MO202042610Medicaid