Basic Information
| Provider Information | |||||||||
| NPI: | 1316994825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEBRASKA ORTHOPAEDIC ASSOCIATES LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 S 144TH ST | ||||||||
| Address2: | #110 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681445243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026370400 | ||||||||
| FaxNumber: | 4026370401 | ||||||||
| Practice Location | |||||||||
| Address1: | 2725 S 144TH ST | ||||||||
| Address2: | #110 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681445243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026370400 | ||||||||
| FaxNumber: | 4026370401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 05/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | GOEBEL | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | X | ||||||||
| AuthorizedOfficialTitleorPosition: | COMPLIANCE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 4026370400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207XX0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 10025238600 | 05 | NE | MEDICAID | CK8121 | 01 | IA | RAILROAD MEDICARE | OTHER | CS8783 | 01 | NE | RAILROAD MEDICARE | OTHER |