Provider Demographics
NPI:1104666536
Name:ATLAS MEDICAL NEBRASKA LLC
Entity type:Organization
Organization Name:ATLAS MEDICAL NEBRASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-514-5646
Mailing Address - Street 1:8214 F ST STE C
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1740
Mailing Address - Country:US
Mailing Address - Phone:402-331-2273
Mailing Address - Fax:402-933-4255
Practice Address - Street 1:8214 F ST STE C
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1740
Practice Address - Country:US
Practice Address - Phone:402-331-2273
Practice Address - Fax:402-933-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty