Provider Demographics
NPI:1083643258
Name:PAPILLION FAMILY MEDICINE P C
Entity Type:Organization
Organization Name:PAPILLION FAMILY MEDICINE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:NAEGELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-502-3600
Mailing Address - Street 1:555 FORTUNE DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3421
Mailing Address - Country:US
Mailing Address - Phone:402-502-3600
Mailing Address - Fax:402-502-3606
Practice Address - Street 1:555 FORTUNE DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3421
Practice Address - Country:US
Practice Address - Phone:402-502-3600
Practice Address - Fax:402-502-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX IDENIFICATION NUMBER