Provider Demographics
NPI:1356345318
Name:NEBRASKA ORTHOPAEDIC HOSPITAL LLC
Entity type:Organization
Organization Name:NEBRASKA ORTHOPAEDIC HOSPITAL LLC
Other - Org Name:
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 1:2808 SOUTH 143RD PLAZA
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5611
Mailing Address - Country:US
Mailing Address - Phone:402-637-0600
Mailing Address - Fax:402-637-0705
Practice Address - Street 1:2808 SOUTH 143RD PLAZA
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5611
Practice Address - Country:US
Practice Address - Phone:402-637-0600
Practice Address - Fax:402-637-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH000105284300000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
601373800OtherDOL OWC
IA0579045Medicaid
NE10025104500Medicaid
601373800OtherDOL OWC