| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2915 Grant St, Omaha, Nebraska |
| Authorized Official Name and Position | Tarsha Jackson (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 4024571200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2915 Grant St Omaha NE 68111-3863 Ph: (402) 453-1433 | 2915 Grant St Omaha NE 68111-3863 Ph: (402) 453-1433 |
| NPI Number | 1871962944 |
|---|---|
| Provider Enumeration Date | 09/18/2015 |
| Last Update Date | 03/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871962944 | NPI | - | NPPES |
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