Provider Demographics
NPI:1326369075
Name:GBGH
Entity Type:Organization
Organization Name:GBGH
Other - Org Name:NEBRASKA NEUROPATHY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEURET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-600-1137
Mailing Address - Street 1:12309 GOLD STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2760
Mailing Address - Country:US
Mailing Address - Phone:402-330-1176
Mailing Address - Fax:402-939-0410
Practice Address - Street 1:12309 GOLD STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2760
Practice Address - Country:US
Practice Address - Phone:402-330-1176
Practice Address - Fax:402-939-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1295937423Medicaid
MO000014134Medicare PIN
MO1295937423Medicaid
MO6468930001Medicare NSC