Provider Demographics
NPI:1861578817
Name:MID-CITY OB-GYN, P.C.
Entity type:Organization
Organization Name:MID-CITY OB-GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-6600
Mailing Address - Street 1:7205 WEST CENTER ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2388
Mailing Address - Country:US
Mailing Address - Phone:402-397-6600
Mailing Address - Fax:402-397-8318
Practice Address - Street 1:7205 WEST CENTER ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2388
Practice Address - Country:US
Practice Address - Phone:402-397-6600
Practice Address - Fax:402-397-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0940734Medicaid
NE=========13Medicaid
IA0655170001Medicare ID - Type UnspecifiedIOWA MEDICARE
NE=========13Medicaid
NE092208Medicare ID - Type Unspecified