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4611 S 96th St Ste 237 Omaha NE 68127-1243 | |
(402) 496-9966 | |
(402) 496-9499 |
Full Name | |
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Speciality | Social Worker |
Location | 4611 S 96th St Ste 237, Omaha, Nebraska |
Authorized Official Name and Position | Susie Romanik (OFFICE MANAGER) |
Authorized Official Contact | 4024969966 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4611 S 96th St Ste 237 Omaha NE 68127-1243 Ph: (402) 496-9966 | 4611 S 96th St Ste 237 Omaha NE 68127-1243 Ph: (402) 496-9966 |
NPI Number | 1346905148 |
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Provider Enumeration Date | 11/05/2021 |
Last Update Date | 08/05/2023 |
Certification Date | 08/05/2023 |
Medicare PECOS PAC ID | 1759822323 |
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Medicare Enrollment ID | O20240923002544 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346905148 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Jessica L Winternheimer |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1295108082 PECOS PAC ID: 3476084856 Enrollment ID: I20241009003425 |
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