| |
25410 Park Ave Apt E Niobrara NE 68760-7044 | |
(402) 857-3398 | |
(402) 857-3315 |
Full Name | |
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Speciality | Clinic/Center |
Location | 25410 Park Ave Apt E, Niobrara, Nebraska |
Authorized Official Name and Position | Douglas Ekeren (CEO/PRESIDENT) |
Authorized Official Contact | 6056688321 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 86370 Sioux Falls SD 57118-6370 Ph: (605) 322-4933 | 25410 Park Ave Apt E Niobrara NE 68760-7044 Ph: (402) 857-3398 |
NPI Number | 1730448671 |
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Provider Enumeration Date | 05/13/2012 |
Last Update Date | 04/24/2023 |
Medicare PECOS PAC ID | 6103729066 |
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Medicare Enrollment ID | O20160818002275 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730448671 | NPI | - | NPPES |
NA1399 | Other | NE | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Santee Sioux Tribe Of Nebraska Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 S Visiting Eagle St, Niobrara, NE 68760 Phone: 402-857-2300 Fax: 402-857-2910 | |
Santee Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 S Visiting Eagle St, Niobrara, NE 68760 Phone: 402-857-2300 Fax: 402-857-2315 |