| Endeveren Family Medicine Llc | |
|
3015 N 90th St Ste 1 Omaha NE 68134-4713 | |
| (402) 453-6869 | |
| (402) 961-1055 |
| Full Name | Endeveren Family Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3015 N 90th St Ste 1, Omaha, Nebraska |
| Authorized Official Name and Position | Nichelle Ree Horton-brown (SOLE MEMBER) |
| Authorized Official Contact | 4024536869 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Endeveren Family Medicine Llc 3015 N 90th St Ste 1 Omaha NE 68134-4713 Ph: (402) 453-6869 | Endeveren Family Medicine Llc 3015 N 90th St Ste 1 Omaha NE 68134-4713 Ph: (402) 453-6869 |
| NPI Number | 1023257763 |
|---|---|
| Provider Enumeration Date | 02/18/2009 |
| Last Update Date | 09/12/2023 |
| Medicare PECOS PAC ID | 1456486224 |
|---|---|
| Medicare Enrollment ID | O20100318000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023257763 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 22626 (Nebraska) | Primary |
| 208000000X | Pediatrics | 22626 (Nebraska) | Secondary |
| Provider Name | Nichelle R Horton Brown |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154376267 PECOS PAC ID: 5193898500 Enrollment ID: I20080717000782 |
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