Basic Information
| Provider Information | |||||||||
| NPI: | 1437144961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALCHOMMALI | ||||||||
| FirstName: | AHMAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 631 N 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MISSOURI VALLEY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515551102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7126422784 | ||||||||
| FaxNumber: | 7126429259 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 N 30TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681312137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024494590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 12/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD-29019 | IA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | 18735 | NE | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | 18735 | NE | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1437144961 | 05 | NE | MEDICAID |