Provider Demographics
NPI:1154351930
Name:JIMENEZ, OMAR F (MD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:F
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 42ND ST STE 2100
Mailing Address - Street 2:RWPC - NEUROSURGERY
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4669
Mailing Address - Country:US
Mailing Address - Phone:308-630-1947
Mailing Address - Fax:308-630-1439
Practice Address - Street 1:2 W 42ND ST STE 2100
Practice Address - Street 2:RWPC NEUROSURGERY
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4669
Practice Address - Country:US
Practice Address - Phone:308-630-1947
Practice Address - Fax:308-630-1439
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24111207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025698000Medicaid
NE10025698000Medicaid