Organization
MIDWEST PAIN CLINIC PC
Active
Other names
Advanced Spine And Joint Care of Nebraska
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN E MAHONEY (CREDENTIALING SPECIALIST)
(402) 391-7246
Entity
Organization
Contact information
Practice address
825 N 90TH ST, OMAHA, NE 68114-2702
(402) 391-7246
(402) 408-1783
Mailing address
825 N 90TH ST, OMAHA, NE 68114-2706
(402) 391-7246
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263940
—
IA
05
—
NA1054
—
NE
05
—
S104099
—
SD
Enumeration date
03/31/2008
Last updated
09/12/2024
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