Provider Demographics
NPI:1083669428
Name:FAMILY HEALTH CARE, PC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAVEDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-572-3145
Mailing Address - Street 1:10105 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5554
Mailing Address - Country:US
Mailing Address - Phone:402-572-3145
Mailing Address - Fax:
Practice Address - Street 1:10105 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5554
Practice Address - Country:US
Practice Address - Phone:402-572-3145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE336729240Medicaid
NEG77111Medicare UPIN
NE270810Medicare ID - Type Unspecified