Provider Demographics
NPI:1215030531
Name:OMAHA NEUROLOGICAL CLINIC INC
Entity type:Organization
Organization Name:OMAHA NEUROLOGICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIEBENTRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-393-2023
Mailing Address - Street 1:10020 NICHOLAS STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2188
Mailing Address - Country:US
Mailing Address - Phone:402-393-2023
Mailing Address - Fax:402-393-3244
Practice Address - Street 1:10020 NICHOLAS STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-393-2023
Practice Address - Fax:402-393-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEC02009OtherRAILROAD MEDICARE
NE01907OtherBCBS OF NE
IA0938977Medicaid
NE=========-13Medicaid
NEC02009OtherRAILROAD MEDICARE