| Liberty Elementary School Based Clinic | |
|
2021 Saint Marys Ave Omaha NE 68102-2415 | |
| (402) 505-8180 | |
| (402) 505-8190 |
| Full Name | Liberty Elementary School Based Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2021 Saint Marys Ave, Omaha, Nebraska |
| Authorized Official Name and Position | Andrea M. Skolkin (CEO) |
| Authorized Official Contact | 4025028842 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberty Elementary School Based Clinic 4920 South 30th Street Suite 103 Omaha NE 68107-1656 Ph: (402) 734-4110 | Liberty Elementary School Based Clinic 2021 Saint Marys Ave Omaha NE 68102-2415 Ph: (402) 505-8180 |
| NPI Number | 1164735759 |
|---|---|
| Provider Enumeration Date | 07/23/2010 |
| Last Update Date | 01/26/2023 |
| Medicare PECOS PAC ID | 3173435153 |
|---|---|
| Medicare Enrollment ID | O20100928001309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164735759 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | HC018 (Nebraska) | Primary |
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