Basic Information
| Provider Information | |||||||||
| NPI: | 1144741406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MULTICARE MEDICAL GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 PINNACLE DR | ||||||||
| Address2: | |||||||||
| City: | PAPILLION | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680466269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025057989 | ||||||||
| FaxNumber: | 4029328863 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 PINNACLE DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | PAPILLION | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680466228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025057989 | ||||||||
| FaxNumber: | 4029328863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BOECKENHAUER | ||||||||
| AuthorizedOfficialFirstName: | TONYA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4025057989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.