| Pure Healthcare Of Nebraska Llc | |
|
3125 N 120th St Omaha NE 68164-2527 | |
| (402) 281-0880 | |
| (402) 939-0427 |
| Full Name | Pure Healthcare Of Nebraska Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3125 N 120th St, Omaha, Nebraska |
| Authorized Official Name and Position | Joshua T Tandy (OWNER) |
| Authorized Official Contact | 8017870731 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pure Healthcare Of Nebraska Llc 4179 S Riverboat Rd Ste 220 Taylorsville UT 84123-2986 Ph: (801) 590-9267 | Pure Healthcare Of Nebraska Llc 3125 N 120th St Omaha NE 68164-2527 Ph: (402) 281-0880 |
| NPI Number | 1275278392 |
|---|---|
| Provider Enumeration Date | 05/03/2022 |
| Last Update Date | 03/17/2023 |
| Medicare PECOS PAC ID | 7214396449 |
|---|---|
| Medicare Enrollment ID | O20230706003353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275278392 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Cassie L Krause |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487915559 PECOS PAC ID: 7315193935 Enrollment ID: I20120813000817 |
| Provider Name | Robert K Mannel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093073181 PECOS PAC ID: 1658683073 Enrollment ID: I20230706003407 |
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