Provider Demographics
NPI:1912712886
Name:THEILER, RICK
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:THEILER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 F ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-1014
Mailing Address - Country:US
Mailing Address - Phone:531-365-8663
Mailing Address - Fax:402-455-2542
Practice Address - Street 1:9416 WESTERN PLZ APT 2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2553
Practice Address - Country:US
Practice Address - Phone:402-431-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEG15004836172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver