Provider Demographics
NPI:1205021102
Name:NEBRASKA UROLOGY CENTER, P.C.
Entity Type:Organization
Organization Name:NEBRASKA UROLOGY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:K
Authorized Official - Last Name:STROMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-462-5109
Mailing Address - Street 1:2115 N KANSAS AVE STE 201
Mailing Address - Street 2:NEBRASKA UROLOGY CENTER
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2636
Mailing Address - Country:US
Mailing Address - Phone:402-462-5109
Mailing Address - Fax:
Practice Address - Street 1:614 S MAIN ST
Practice Address - Street 2:SMITH COUNTY MEMORIAL HOSPITAL
Practice Address - City:SMITH CENTER
Practice Address - State:KS
Practice Address - Zip Code:66967-3001
Practice Address - Country:US
Practice Address - Phone:402-462-5109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0420442208800000X
KS0423520208800000X
KS1500834363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100203450BMedicaid
KS100203450BMedicaid