Provider Demographics
NPI:1104078542
Name:BRITT A. THEDINGER, MD, PC
Entity type:Organization
Organization Name:BRITT A. THEDINGER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITT
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:THEDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-933-3277
Mailing Address - Street 1:9202 WEST DODGE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3318
Mailing Address - Country:US
Mailing Address - Phone:402-933-3277
Mailing Address - Fax:402-933-2216
Practice Address - Street 1:9202 W DODGE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3318
Practice Address - Country:US
Practice Address - Phone:402-933-3277
Practice Address - Fax:402-933-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18188207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE1801895826Medicare NSC
NE=========00Medicaid