Provider Demographics
NPI:1033184866
Name:NEBRASKA URBAN INDIAN HEALTH COALITION, INC.
Entity Type:Organization
Organization Name:NEBRASKA URBAN INDIAN HEALTH COALITION, INC.
Other - Org Name:NEBRASKA URBAN INDIAN MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POLK-PRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-346-0902
Mailing Address - Street 1:2240 LANDON CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2414
Mailing Address - Country:US
Mailing Address - Phone:402-346-0902
Mailing Address - Fax:402-342-5290
Practice Address - Street 1:2331 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1348
Practice Address - Country:US
Practice Address - Phone:402-434-7177
Practice Address - Fax:402-434-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHC041261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE281804Medicare Oscar/Certification
NE099893Medicare Oscar/Certification