Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 203 W 4th St, Wilber, Nebraska |
Authorized Official Name and Position | Julie Lacy (PRESIDENT & CEO) |
Authorized Official Contact | 4028262102 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 860873 Minneapolis MN 55486-0873 Ph: (402) 826-2102 | 203 W 4th St Wilber NE 68465-2457 Ph: (402) 821-3293 |
NPI Number | 1588614481 |
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Provider Enumeration Date | 05/11/2006 |
Last Update Date | 11/25/2024 |
Medicare PECOS PAC ID | 4385556216 |
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Medicare Enrollment ID | O20040709000675 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588614481 | NPI | - | NPPES |
10025116800 | Medicaid | NE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |