Provider Demographics
NPI:1750877510
Name:COLLABORATIVE CARE ASSOCIATES PC
Entity type:Organization
Organization Name:COLLABORATIVE CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-317-6491
Mailing Address - Street 1:3410 N 140TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5400
Mailing Address - Country:US
Mailing Address - Phone:402-317-6491
Mailing Address - Fax:
Practice Address - Street 1:3410 N 140TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5400
Practice Address - Country:US
Practice Address - Phone:402-317-6491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty