Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 76 W 8th St, Nelson, Nebraska |
Authorized Official Name and Position | Treg Vyzourek (CEO) |
Authorized Official Contact | 4028793281 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 407 Superior NE 68978-0407 Ph: (402) 879-4781 | 76 W 8th St Nelson NE 68961-6130 Ph: (402) 225-2375 |
NPI Number | 1114999547 |
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Provider Enumeration Date | 02/01/2006 |
Last Update Date | 03/23/2022 |
Medicare PECOS PAC ID | 4082513015 |
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Medicare Enrollment ID | O20040311001136 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114999547 | NPI | - | NPPES |
10025184500 | Medicaid | NE | |
10025288600 | Medicaid | NE |