Provider Demographics
NPI:1083225817
Name:KUBAT CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:KUBAT CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-315-1944
Mailing Address - Street 1:4924 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3219
Mailing Address - Country:US
Mailing Address - Phone:402-558-8888
Mailing Address - Fax:402-558-7388
Practice Address - Street 1:4924 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3219
Practice Address - Country:US
Practice Address - Phone:402-558-8888
Practice Address - Fax:402-558-7388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERCIPIO KP HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-14
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center