Provider Demographics
NPI:1053385328
Name:MIDWEST ENDOSCOPY SERVICES LLC
Entity type:Organization
Organization Name:MIDWEST ENDOSCOPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-7057
Mailing Address - Street 1:8901 INDIAN HILLS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4057
Mailing Address - Country:US
Mailing Address - Phone:402-933-1500
Mailing Address - Fax:402-934-1612
Practice Address - Street 1:8901 INDIAN HILLS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4057
Practice Address - Country:US
Practice Address - Phone:402-933-1500
Practice Address - Fax:402-934-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEASC062261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE098865Medicare PIN