Provider Demographics
NPI:1154190338
Name:NEBRASKA WELLNESS GROUP
Entity type:Organization
Organization Name:NEBRASKA WELLNESS GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOC. DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:IZAAK
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-218-1242
Mailing Address - Street 1:4848 S 120TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2064
Mailing Address - Country:US
Mailing Address - Phone:402-218-1242
Mailing Address - Fax:402-218-1243
Practice Address - Street 1:11837 MIRACLE HILLS DR STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4418
Practice Address - Country:US
Practice Address - Phone:402-218-1242
Practice Address - Fax:402-218-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty