Provider Demographics
NPI:1831278993
Name:SOTERIA FAMILY CLINIC
Entity type:Organization
Organization Name:SOTERIA FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLATOKUNBO
Authorized Official - Middle Name:OLUFUNMIKE
Authorized Official - Last Name:AWODELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-505-6900
Mailing Address - Street 1:PO BOX 34729
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-0729
Mailing Address - Country:US
Mailing Address - Phone:402-505-6900
Mailing Address - Fax:402-991-5419
Practice Address - Street 1:1941 S 42ND ST
Practice Address - Street 2:SUITE 434
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-505-6900
Practice Address - Fax:402-991-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099577Medicare ID - Type UnspecifiedGROUP NUMBER