Provider Demographics
NPI:1164459509
Name:FREMONT MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:FREMONT MEDICAL ASSOCIATES, P.C.
Other - Org Name:THE SURGICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DREYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-721-6333
Mailing Address - Street 1:2350 N CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2312
Mailing Address - Country:US
Mailing Address - Phone:402-721-6333
Mailing Address - Fax:402-721-6320
Practice Address - Street 1:2350 N CLARKSON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2312
Practice Address - Country:US
Practice Address - Phone:402-721-6333
Practice Address - Fax:402-721-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE096892Medicare ID - Type UnspecifiedDIVISION MEDICARE NUMBER