Provider Demographics
NPI:1073744694
Name:THE FAMILY DOC, LLC
Entity Type:Organization
Organization Name:THE FAMILY DOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DG
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-933-4111
Mailing Address - Street 1:2211 CAPEHART RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2121
Mailing Address - Country:US
Mailing Address - Phone:402-933-4111
Mailing Address - Fax:402-934-4111
Practice Address - Street 1:2211 CAPEHART RD STE 103
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-2121
Practice Address - Country:US
Practice Address - Phone:402-933-4111
Practice Address - Fax:402-934-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty