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Mallory Leigh Pottebaum

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

This provider is enrolled in PECOS as MALLORY POTTEBAUM.

Based on the most recent information from CMS, provider Mallory Leigh Pottebaum is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1487950945
Provider Type
Individual
Full Name
Pottebaum, Mallory Leigh
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
2/1/2011
Last Updated
6/25/2019

Contact Information

Practice Location

505 S. 45th St, Omaha, NE 68198-0001

(402) 559-5600

Unlisted Fax

Mailing Location

988102 Nebraska Medical Ctr, Omaha, NE 68198-8102

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 1997 Nebraska

Mallory Leigh Pottebaum

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Nguyen, Alyna

Mcgrail, Molly Susan

Yoshida, Noah K

Wheeler, Angela

Gajewski, John

Hanson, Kora

Krajewski, Alexa

Shah, Simran Dharmesh

Torczon, Carrie Lynn

Peavy, Jillian M