| Blue Lotus Primary Care | |
|
11819 Miracle Hills Dr Omaha NE 68154-5308 | |
| (402) 650-6661 | |
| Not Available |
| Full Name | Blue Lotus Primary Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 11819 Miracle Hills Dr, Omaha, Nebraska |
| Authorized Official Name and Position | Brandi Anderson (OFFICE MANAGER) |
| Authorized Official Contact | 4023568601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Lotus Primary Care 11819 Miracle Hills Dr Ste 105 Omaha NE 68154-4428 Ph: (402) 356-8601 | Blue Lotus Primary Care 11819 Miracle Hills Dr Omaha NE 68154-5308 Ph: (402) 650-6661 |
| NPI Number | 1073221974 |
|---|---|
| Provider Enumeration Date | 11/09/2022 |
| Last Update Date | 07/23/2024 |
| Medicare PECOS PAC ID | 5496119554 |
|---|---|
| Medicare Enrollment ID | O20230908000724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073221974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Clayton Bates Schroeder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922128602 PECOS PAC ID: 5092883124 Enrollment ID: I20081002000493 |
| Provider Name | Amanda J Worner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780014944 PECOS PAC ID: 3476785221 Enrollment ID: I20150210000618 |
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