Provider Demographics
NPI:1194374066
Name:TODD LUEDEKE PC
Entity Type:Organization
Organization Name:TODD LUEDEKE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:LUEDEKE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:402-369-4763
Mailing Address - Street 1:85726 575TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NE
Mailing Address - Zip Code:68787-8032
Mailing Address - Country:US
Mailing Address - Phone:402-369-4763
Mailing Address - Fax:
Practice Address - Street 1:201 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-1706
Practice Address - Country:US
Practice Address - Phone:402-369-4763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty