Provider Demographics
NPI:1265513857
Name:MCTAGGART OB-GYN, P.C.
Entity type:Organization
Organization Name:MCTAGGART OB-GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCTAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-614-2233
Mailing Address - Street 1:1910 S 72ND ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1743
Mailing Address - Country:US
Mailing Address - Phone:402-614-2233
Mailing Address - Fax:402-397-5925
Practice Address - Street 1:1910 S 72ND ST
Practice Address - Street 2:SUITE 206
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1743
Practice Address - Country:US
Practice Address - Phone:402-614-2233
Practice Address - Fax:402-397-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18286207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024951000Medicaid
NE10024951000Medicaid