Provider Demographics
NPI:1114409984
Name:PREMIER ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:PREMIER ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-219-3873
Mailing Address - Street 1:8560 FOXTAIL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6140
Mailing Address - Country:US
Mailing Address - Phone:402-219-3873
Mailing Address - Fax:402-499-3245
Practice Address - Street 1:8560 FOXTAIL DR STE 201
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-6140
Practice Address - Country:US
Practice Address - Phone:402-219-3873
Practice Address - Fax:402-499-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026748200Medicaid