Provider Demographics
NPI:1114331774
Name:PROMEDCARE, INC.
Entity Type:Organization
Organization Name:PROMEDCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VP
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOXHOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-727-7900
Mailing Address - Street 1:426 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2633
Mailing Address - Country:US
Mailing Address - Phone:402-727-7900
Mailing Address - Fax:402-727-7904
Practice Address - Street 1:3100 23RD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3161
Practice Address - Country:US
Practice Address - Phone:402-564-7900
Practice Address - Fax:402-564-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE11689277Medicaid
NE6626800002Medicare NSC