Organization
MD WEST ONE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MAUREEN FREDRICKS (BUSINESS OFFICE SUPERVISOR)
(402) 361-5260
Entity
Organization
Contact information
Practice address
222 N 192ND STREET, ELKHORN, NE 68022-5363
(402) 390-4111
(402) 390-4115
Mailing address
8005 FARNAM DR STE 305, OMAHA, NE 68114-3426
(402) 390-4111
(402) 399-8455
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
02/01/2022
Last updated
01/31/2023
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