Basic Information
| Provider Information | |||||||||
| NPI: | 1114162401 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MD WEST ONE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8005 FARNAM DR | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681143426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023989243 | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 ESSIE DAVISON DR | ||||||||
| Address2: | |||||||||
| City: | CLARINDA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516322915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125428325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2008 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | SOLEDAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4023989243 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.