Provider Demographics
NPI:1811926629
Name:OMAHA INTERNAL MEDICINE, PC
Entity type:Organization
Organization Name:OMAHA INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCATEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-393-1000
Mailing Address - Street 1:1805 N 145TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1179
Mailing Address - Country:US
Mailing Address - Phone:402-393-1000
Mailing Address - Fax:402-496-7194
Practice Address - Street 1:1805 N 145TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1179
Practice Address - Country:US
Practice Address - Phone:402-393-1000
Practice Address - Fax:402-496-7194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025077300Medicaid
NE10025077300Medicaid
NE099459Medicare PIN
NEDA4709Medicare PIN