| Brooke Boggs Llc | |
|
403 Lexington Cir Grand Island NE 68803-9728 | |
| (308) 227-6119 | |
| (308) 888-0018 |
| Full Name | Brooke Boggs Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 403 Lexington Cir, Grand Island, Nebraska |
| Authorized Official Name and Position | Brooke Nicole Boggs (OWNER/PROVIDER) |
| Authorized Official Contact | 3085306569 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brooke Boggs Llc 403 Lexington Cir Grand Island NE 68803-9728 Ph: (308) 227-6119 | Brooke Boggs Llc 403 Lexington Cir Grand Island NE 68803-9728 Ph: (308) 227-6119 |
| NPI Number | 1396300562 |
|---|---|
| Provider Enumeration Date | 05/03/2019 |
| Last Update Date | 12/10/2020 |
| Medicare PECOS PAC ID | 6002142619 |
|---|---|
| Medicare Enrollment ID | O20190719000401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396300562 | NPI | - | NPPES |
| 50511752800 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Brooke Nicole Boggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033556113 PECOS PAC ID: 7214226448 Enrollment ID: I20160512001992 |
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