Provider Demographics
| NPI: | 1275641904 |
|---|---|
| Name: | ORTHOWEST LLC |
| Entity type: | Organization |
| Organization Name: | ORTHOWEST LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TARA |
| Authorized Official - Middle Name: | L |
| Authorized Official - Last Name: | WISDOM |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 402-609-1002 |
| Mailing Address - Street 1: | 2725 SOUTH 144TH STREET |
| Mailing Address - Street 2: | SUITE 212 |
| Mailing Address - City: | OMAHA |
| Mailing Address - State: | NE |
| Mailing Address - Zip Code: | 68144-5253 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 402-637-0800 |
| Mailing Address - Fax: | 402-637-0852 |
| Practice Address - Street 1: | 2725 SOUTH 144TH STREET |
| Practice Address - Street 2: | SUITE 212 |
| Practice Address - City: | OMAHA |
| Practice Address - State: | NE |
| Practice Address - Zip Code: | 68144-5253 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 402-637-0800 |
| Practice Address - Fax: | 402-637-0852 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-25 |
| Last Update Date: | 2025-07-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 207PS0010X | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine | Group - Multi-Specialty |
| No | 207QS0010X | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
| No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
| No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | ||
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IA | CJ8688 | Other | MEDICARE RAILROAD |
| IA | 554683 | Medicaid | |
| NE | CJ8687 | Other | MEDICARE RAILROAD |
| IA | 554683 | Medicaid | |
| IA | I6060 | Medicare PIN | |
| NE | 4890300001 | Medicare NSC |
